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General NPI Number Information
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NPI Number | 1629564489
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Entity Type | Organization
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Legal Business Name | BEYOND THE COUCH, LLC
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 07/05/2018
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Provider Practice Location Address
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Address Line | 516 S 10TH ST STE 119
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-3511
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Country | US
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Telephone | 904-863-6746
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Fax | 347-412-5958
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Provider Business Mailing Address
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Address Line | PO BOX 15905
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City | FERNANDINA BEACH
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State | FL
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Zip | 32035-3116
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Country | US
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Telephone | 904-863-6746
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Fax | 347-412-5958
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | DR. JULIE DIANE EBERWEIN
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Credential | PHD., LMHC, CAP
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Telephone | 904-863-6746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH9903
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License Number State | FL
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