Provider Demographics
NPI:1710423041
Name:LIFESPAN COUNSELING AT THE KIDS COUCH INC LLC
Entity Type:Organization
Organization Name:LIFESPAN COUNSELING AT THE KIDS COUCH INC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:YATZUS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCMH
Authorized Official - Phone:302-384-8222
Mailing Address - Street 1:5700 KIRKWOOD HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4857
Mailing Address - Country:US
Mailing Address - Phone:302-384-8222
Mailing Address - Fax:302-407-6698
Practice Address - Street 1:5700 KIRKWOOD HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4857
Practice Address - Country:US
Practice Address - Phone:302-384-8222
Practice Address - Fax:302-407-6698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000362101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty