Provider Demographics
NPI:1467025965
Name:COUCH COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:COUCH COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DERREKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:920-872-7292
Mailing Address - Street 1:806 VALLEY RD STE 13
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1012
Mailing Address - Country:US
Mailing Address - Phone:920-872-7292
Mailing Address - Fax:920-872-7066
Practice Address - Street 1:806 VALLEY RD STE 13
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1012
Practice Address - Country:US
Practice Address - Phone:920-872-7292
Practice Address - Fax:920-872-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1104418318OtherPRIVATE INSURANCE
WI1104418318Medicaid