Healthcare Provider Details

I. General information

NPI: 1235148065
Provider Name (Legal Business Name): JEREMY S COUCH L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 HOMER CLAYTON DR
GUNTERSVILLE AL
35976-2207
US

IV. Provider business mailing address

304 ARAD THOMPSON RD NE
ARAB AL
35016-2733
US

V. Phone/Fax

Practice location:
  • Phone: 256-582-3203
  • Fax: 256-582-3216
Mailing address:
  • Phone: 256-653-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2399
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2399
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: