Provider Demographics
NPI:1952979338
Name:COUCH MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:COUCH MENTAL HEALTH LLC
Other - Org Name:SPIRIT IN LIGHT HEALING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CT
Authorized Official - Phone:208-280-0365
Mailing Address - Street 1:1426 ADDISON AVE E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5202
Mailing Address - Country:US
Mailing Address - Phone:208-280-0365
Mailing Address - Fax:208-549-7253
Practice Address - Street 1:1426 ADDISON AVE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5202
Practice Address - Country:US
Practice Address - Phone:208-280-0365
Practice Address - Fax:208-549-7253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty