MEDICARE: GET OFF THE COUCH COUNSELING, LLC

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	1041C0700X	Clinical Social Worker	SW11095	FL

General Provider Information

NPI Number	:	1417430240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GET OFF THE COUCH COUNSELING, LLC

Provider Business Mailing Address
First Line	:	50 LEANNI WAY UNIT C4
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-4755
Country	:	US
Telephone Number	:	386-627-8156
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 LEANNI WAY UNIT C4
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-4755
Country	:	US
Telephone Number	:	386-627-8156
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	KIMBERLY DEVINE
Credential	:	LCSW
Telephone Number	:	386-867-8156

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	09/11/2020

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