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General NPI Number Information
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NPI Number | 1548842263
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Entity Type | Individual
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Provider Name | SAVANNAH COUCH
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Gender | Female
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 2130 GREEN BAY RD
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City | EVANSTON
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State | IL
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Zip | 60201-3026
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Country | US
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Telephone | 847-425-9708
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 W MORSE AVE APT 202
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City | CHICAGO
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State | IL
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Zip | 60626-3347
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Country | US
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Telephone | 407-927-6860
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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 | 101200000X
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Taxonomy Name | Drama Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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