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General NPI Number Information
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NPI Number | 1487999736
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Entity Type | Individual
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Provider Name | DEANA JUDITH COUCH CRC, LPCC-S
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Gender | Female
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 13172 MAIN ST # 55
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City | WESTON
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State | OH
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Zip | 43569-9990
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Country | US
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Telephone | 419-806-5688
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Fax | 419-754-2609
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Provider Business Mailing Address
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Address Line | PO BOX 55
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City | WESTON
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State | OH
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Zip | 43569-0055
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Country | US
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Telephone | 419-936-7744
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401223497
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 00094728
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E-2001973-SUPV
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License Number State | OH
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