Provider Demographics
NPI:1679216410
Name:COUCH, LORI LYNETTE (APSS)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNETTE
Last Name:COUCH
Suffix:
Gender:F
Credentials:APSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6428 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40374-8001
Mailing Address - Country:US
Mailing Address - Phone:859-398-3725
Mailing Address - Fax:
Practice Address - Street 1:5 CLEVELAND AVE STE 206
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1950
Practice Address - Country:US
Practice Address - Phone:859-585-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0000000000000000OtherADULT PEER SUPPORT SPECIALIST