Provider Demographics
NPI:1578932141
Name:COUCH, BRITTANY SIMONE I
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:SIMONE
Last Name:COUCH
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 NE 13TH ST
Mailing Address - Street 2:PO BOX 53277
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1022
Mailing Address - Country:US
Mailing Address - Phone:405-308-5876
Mailing Address - Fax:405-522-6350
Practice Address - Street 1:1200 NE 13TH ST
Practice Address - Street 2:ATTN: B.COUCH, STARS
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1022
Practice Address - Country:US
Practice Address - Phone:405-308-5876
Practice Address - Fax:405-522-6350
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator