Healthcare Provider Details

I. General information

NPI: 1740155886
Provider Name (Legal Business Name): FROM MY SIDE OF THE COUCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 42ND ST NE
SAINT MICHAEL MN
55376-3020
US

IV. Provider business mailing address

9890 42ND ST NE
SAINT MICHAEL MN
55376-3020
US

V. Phone/Fax

Practice location:
  • Phone: 321-458-5663
  • Fax: 763-355-9169
Mailing address:
  • Phone: 321-458-5663
  • Fax: 763-355-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA ELIZABETH KATZ
Title or Position: OWNER/OPERATOR
Credential: MS, LCMHC, LMHC, LPC
Phone: 321-458-5663