Healthcare Provider Details

I. General information

NPI: 1487999736
Provider Name (Legal Business Name): DEANA JUDITH COUCH CRC, LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13172 MAIN ST # 55
WESTON OH
43569-9990
US

IV. Provider business mailing address

PO BOX 55
WESTON OH
43569-0055
US

V. Phone/Fax

Practice location:
  • Phone: 419-806-5688
  • Fax: 419-754-2609
Mailing address:
  • Phone: 419-936-7744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401223497
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00094728
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-2001973-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: