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NPI Code Detail

MEDICARE: COUNSELING OFF THE COUCH L.L.C.

MEDICARE: COUNSELING OFF THE COUCH L.L.C.
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
1261QM0855XAdolescent and Children Mental Health Clinic/Center
2261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1700661618
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNSELING OFF THE COUCH L.L.C.
Provider Business Mailing Address
First Line : 26922 STATE ROUTE 784
Second Line :
City : GRAYSON
State : KY
Zip : 41143-6565
Country : US
Telephone Number : 606-315-8822
Fax Number :
Provider Business Practice Location Address
First Line : 332 15TH ST
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7626
Country : US
Telephone Number : 606-315-8822
Fax Number :
Authorized Official
Title or Position : OWNER/PRIMARY THERAPIST
Name : PETER SMITH
Credential : LPCC
Telephone Number : 606-315-8822
Provider Enumeration Date : 08/29/2023
Last Update Date : 08/07/2024

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Directions to “COUNSELING OFF THE COUCH L.L.C. ” Practice Location

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