Provider Demographics
NPI:1639689128
Name:COUCH, MARTHA GANZ
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:GANZ
Last Name:COUCH
Suffix:
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 1:5700 EAGLE MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-4262
Mailing Address - Country:US
Mailing Address - Phone:972-890-2520
Mailing Address - Fax:
Practice Address - Street 1:3900 ROSELAWN DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-2308
Practice Address - Country:US
Practice Address - Phone:972-800-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73227101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional