Healthcare Provider Details

I. General information

NPI: 1407500978
Provider Name (Legal Business Name): ASHLEY RENEE COUCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY RENEE LACHANCE LCSW

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 OAKFIELD DR STE 206
BRANDON FL
33511-4954
US

IV. Provider business mailing address

122 HICKORY CREEK BLVD
BRANDON FL
33511-8061
US

V. Phone/Fax

Practice location:
  • Phone: 754-800-3261
  • Fax:
Mailing address:
  • Phone: 754-800-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW18076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: