Provider Demographics
NPI:1003675091
Name:ON THE COUCH COUNSELING AND THERAPY SERVICES LLC
Entity type:Organization
Organization Name:ON THE COUCH COUNSELING AND THERAPY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW, LCSW
Authorized Official - Phone:719-281-4789
Mailing Address - Street 1:1317 N VERMILLION CT
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1345
Mailing Address - Country:US
Mailing Address - Phone:425-903-1103
Mailing Address - Fax:
Practice Address - Street 1:503 N MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3138
Practice Address - Country:US
Practice Address - Phone:719-281-4789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6L304OtherMEDICARE/COMMERCIAL INSURANCE
CO6L3403Medicaid
CO6L3403OtherMEDICARE/COMMERCIAL INSURANCE