Provider Demographics
NPI:1770767428
Name:COUCH, CHRISTINA LIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:LIN
Last Name:COUCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 1ST AVE SE STE 309
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3221
Mailing Address - Country:US
Mailing Address - Phone:319-693-6996
Mailing Address - Fax:888-529-6759
Practice Address - Street 1:4403 1ST AVE SE STE 309
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3221
Practice Address - Country:US
Practice Address - Phone:319-693-6996
Practice Address - Fax:888-529-6759
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12-019103TC0700X
IA114176103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR191430719Medicaid
AR4A313Medicare PIN