=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356160782
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELISABETH M COUTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2024
-----------------------------------------------------
Last Update Date | 12/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2992 KEW DR
-----------------------------------------------------
City | COVENTRY TOWNSHIP
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44319-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-617-5005
-----------------------------------------------------
Fax | 330-617-5639
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 645 HOWE AVE # 1149
-----------------------------------------------------
City | CUYAHOGA FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44221-4955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-617-5005
-----------------------------------------------------
Fax | 330-617-5639
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELISABETH M COUTS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-617-5005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------