Provider Demographics
NPI:1447591318
Name:COUTURE, MARK J (LPC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:COUTURE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 HALL AVE
Mailing Address - Street 2:CTSTRT
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7726
Mailing Address - Country:US
Mailing Address - Phone:860-670-5120
Mailing Address - Fax:
Practice Address - Street 1:710 MAIN ST
Practice Address - Street 2:BLDG. 3, SUIT 9
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1565
Practice Address - Country:US
Practice Address - Phone:860-670-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-02
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002316101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health