Provider Demographics
NPI: | 1679136576 |
---|---|
Name: | COUCH THERAPY, LLC |
Entity Type: | Organization |
Organization Name: | COUCH THERAPY, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | SARAH |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | COUCH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LISW-CP |
Authorized Official - Phone: | 864-304-9496 |
Mailing Address - Street 1: | 372 DOBSON RD |
Mailing Address - Street 2: | |
Mailing Address - City: | DUNCAN |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29334-9758 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 864-304-9496 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 306B W POINSETT ST |
Practice Address - Street 2: | |
Practice Address - City: | GREER |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29650-1548 |
Practice Address - Country: | US |
Practice Address - Phone: | 864-304-9496 |
Practice Address - Fax: | 864-499-8337 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-04-16 |
Last Update Date: | 2019-04-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | SW1378 | Medicaid |