Provider Demographics
NPI:1457692378
Name:COUCH, ELIZABETH RUTH (BCBA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RUTH
Last Name:COUCH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 ATLANTIC PALMS LANE
Mailing Address - Street 2:APARTMENT 922
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9298
Mailing Address - Country:US
Mailing Address - Phone:864-804-7860
Mailing Address - Fax:
Practice Address - Street 1:480 JESSEN LANE
Practice Address - Street 2:SUITE D
Practice Address - City:WANDO
Practice Address - State:SC
Practice Address - Zip Code:29492-7195
Practice Address - Country:US
Practice Address - Phone:843-881-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-13-13023103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst