Provider Demographics
NPI:1295248425
Name:THE DYSFUNCTIONAL COUCH
Entity type:Organization
Organization Name:THE DYSFUNCTIONAL COUCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:918-638-4219
Mailing Address - Street 1:3839 S BOULEVARD STE 200
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5495
Mailing Address - Country:US
Mailing Address - Phone:918-638-4219
Mailing Address - Fax:
Practice Address - Street 1:3839 S BOULEVARD STE 200
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5495
Practice Address - Country:US
Practice Address - Phone:918-638-4219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5358101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200389800BMedicaid