Healthcare Provider Details

I. General information

NPI: 1700661618
Provider Name (Legal Business Name): COUNSELING OFF THE COUCH L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 15TH ST
ASHLAND KY
41101-7626
US

IV. Provider business mailing address

26922 STATE ROUTE 784
GRAYSON KY
41143-6565
US

V. Phone/Fax

Practice location:
  • Phone: 606-315-8822
  • Fax:
Mailing address:
  • Phone: 606-315-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER SMITH
Title or Position: OWNER/PRIMARY THERAPIST
Credential: LPCC
Phone: 606-315-8822