Provider Demographics
NPI:1417398447
Name:COUCH, ALFRED DONNELL SR (LADAC II, NCACI, ADS)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:DONNELL
Last Name:COUCH
Suffix:SR
Gender:M
Credentials:LADAC II, NCACI, ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 PARK AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5214
Mailing Address - Country:US
Mailing Address - Phone:901-428-4287
Mailing Address - Fax:901-366-4260
Practice Address - Street 1:ST. FRANCIS MED BLDG,LOEWENBERG BLDG, STE 406 6005 PARK
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-566-9020
Practice Address - Fax:901-366-4260
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000000201101YA0400X
TNL000000033783101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health