=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306663042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREEN COUCH COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2024
-----------------------------------------------------
Last Update Date | 09/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 STEBBINS ST
-----------------------------------------------------
City | SAINT ALBANS
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05478-2462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-868-1566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1265 RICHFORD RD
-----------------------------------------------------
City | RICHFORD
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05476-9100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MEGHAN CORRIGAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 802-782-5808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------