Provider Demographics
NPI:1518588524
Name:LISA Y COUCH, PHD, PLLC
Entity Type:Organization
Organization Name:LISA Y COUCH, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-934-1499
Mailing Address - Street 1:539 W COMMERCE ST STE 2058
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1953
Mailing Address - Country:US
Mailing Address - Phone:469-474-1146
Mailing Address - Fax:
Practice Address - Street 1:801 N GOLIAD ST
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2717
Practice Address - Country:US
Practice Address - Phone:214-934-1499
Practice Address - Fax:972-323-3485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty