Healthcare Provider Details

I. General information

NPI: 1033024989
Provider Name (Legal Business Name): QUEEN COUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 HILLBROOKE TRL STE 3
TALLAHASSEE FL
32311-7902
US

IV. Provider business mailing address

2300 BLUFF OAK WAY APT 2308
TALLAHASSEE FL
32311-6124
US

V. Phone/Fax

Practice location:
  • Phone: 850-299-4862
  • Fax:
Mailing address:
  • Phone: 888-922-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-515917
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: