Provider Demographics
NPI:1629564489
Name:BEYOND THE COUCH, LLC
Entity Type:Organization
Organization Name:BEYOND THE COUCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:EBERWEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, CAP
Authorized Official - Phone:904-863-6746
Mailing Address - Street 1:PO BOX 15905
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32035-3116
Mailing Address - Country:US
Mailing Address - Phone:904-863-6746
Mailing Address - Fax:347-412-5958
Practice Address - Street 1:516 S 10TH ST STE 119
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3511
Practice Address - Country:US
Practice Address - Phone:904-863-6746
Practice Address - Fax:347-412-5958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9903101YM0800X
251S00000X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001116400Medicaid