Provider Demographics
NPI:1669285425
Name:PINK COUCH THERAPY
Entity type:Organization
Organization Name:PINK COUCH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWODUNNI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:718-207-8900
Mailing Address - Street 1:265 SLATER ST APT 416
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-8922
Mailing Address - Country:US
Mailing Address - Phone:718-207-8900
Mailing Address - Fax:
Practice Address - Street 1:265 SLATER ST APT 416
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8922
Practice Address - Country:US
Practice Address - Phone:718-207-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health