Provider Demographics
NPI:1255687521
Name:COUCH, KATHLEEN (LCSW, CT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:COUCH
Suffix:
Gender:F
Credentials:LCSW, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 FEATHER AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4770
Mailing Address - Country:US
Mailing Address - Phone:208-280-0365
Mailing Address - Fax:208-549-7253
Practice Address - Street 1:1426 ADDISON AVE E STE A
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5202
Practice Address - Country:US
Practice Address - Phone:208-280-0365
Practice Address - Fax:208-549-7253
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty