Healthcare Provider Details

I. General information

NPI: 1336561265
Provider Name (Legal Business Name): COUCHIMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2014
Last Update Date: 01/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 LIME KILN LN SUITE B
LOUISVILLE KY
40222-3429
US

IV. Provider business mailing address

2415 LIME KILN LN SUITE B
LOUISVILLE KY
40222-3429
US

V. Phone/Fax

Practice location:
  • Phone: 844-692-6824
  • Fax: 502-414-4558
Mailing address:
  • Phone: 844-692-6824
  • Fax: 502-414-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number31948
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number31948
License Number StateKY

VIII. Authorized Official

Name: DR. ORA FRANKEL
Title or Position: CEO/OWNER
Credential: MD
Phone: 844-692-6824