Healthcare Provider Details

I. General information

NPI: 1255792503
Provider Name (Legal Business Name): JENNIFER COUCH LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4135 DIXIE HWY
ELSMERE KY
41018-1815
US

IV. Provider business mailing address

615 ELSINORE PL STE 200
CINCINNATI OH
45202-1459
US

V. Phone/Fax

Practice location:
  • Phone: 513-834-7063
  • Fax:
Mailing address:
  • Phone: 513-834-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number242571
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: