Healthcare Provider Details

I. General information

NPI: 1679136576
Provider Name (Legal Business Name): COUCH THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306B W POINSETT ST
GREER SC
29650-1548
US

IV. Provider business mailing address

372 DOBSON RD
DUNCAN SC
29334-9758
US

V. Phone/Fax

Practice location:
  • Phone: 864-304-9496
  • Fax: 864-499-8337
Mailing address:
  • Phone: 864-304-9496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierSW1378
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: MS. SARAH E COUCH
Title or Position: OWNER
Credential: LISW-CP
Phone: 864-304-9496