Healthcare Provider Details

I. General information

NPI: 1467115493
Provider Name (Legal Business Name): THE COUCH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2021
Last Update Date: 10/17/2021
Certification Date: 10/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 W AMERICANA TER STE 320
BOISE ID
83706-2548
US

IV. Provider business mailing address

3901 W STACY DR
BOISE ID
83703-4853
US

V. Phone/Fax

Practice location:
  • Phone: 208-615-5973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GWENDOLYN GAUSSE
Title or Position: CEO
Credential:
Phone: 208-615-6973