MEDICARE: JESSICA R COUCH MA, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401011566	MI

General Provider Information

NPI Number	:	1356614051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA R COUCH MA, LPC, NCC

Provider Business Mailing Address
First Line	:	42815 GARFIELD RD
Second Line	:	SUITE 210
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1143
Country	:	US
Telephone Number	:	586-212-8218
Fax Number	:

Provider Business Practice Location Address
First Line	:	42815 GARFIELD RD
Second Line	:	SUITE 210
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1143
Country	:	US
Telephone Number	:	586-212-8218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2012
Last Update Date	:	11/16/2016

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