Provider Demographics
NPI:1417992587
Name:THE KIDS' COUCH, INC.
Entity Type:Organization
Organization Name:THE KIDS' COUCH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:YATZUS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCMH
Authorized Official - Phone:302-633-0301
Mailing Address - Street 1:240 N JAMES ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-3169
Mailing Address - Country:US
Mailing Address - Phone:302-633-0301
Mailing Address - Fax:302-633-0331
Practice Address - Street 1:240 N JAMES ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-3169
Practice Address - Country:US
Practice Address - Phone:302-633-0301
Practice Address - Fax:302-633-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000362101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02128Medicare ID - Type UnspecifiedKIDS' COUCH GROUP #