MEDICARE: THE COUCH COUNSELING SERVICES, PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1902688740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COUCH COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	7603 WOODVIEW DR
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-4174
Country	:	US
Telephone Number	:	248-762-4294
Fax Number	:

Provider Business Practice Location Address
First Line	:	7603 WOODVIEW DR
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-4174
Country	:	US
Telephone Number	:	248-762-4294
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JENNIFER R GENUISE
Credential	:	LPC
Telephone Number	:	248-762-4294

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	10/17/2023

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