Healthcare Provider Details

I. General information

NPI: 1639966518
Provider Name (Legal Business Name): MICHAEL COUTURE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 TOLL GATE RD STE 309
WARWICK RI
02886-4463
US

IV. Provider business mailing address

1404 SOUTH COUNTY TRAIL UNIT 202
EAST GREENWICH RI
02818-0281
US

V. Phone/Fax

Practice location:
  • Phone: 401-871-3211
  • Fax:
Mailing address:
  • Phone: 401-302-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: