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General NPI Number Information
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NPI Number | 1740358845
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Entity Type | Individual
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Provider Name | LARON MICHELLE COUCH BA, MHPP
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Gender | Female
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1109 BURMAN DR
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City | JACKSONVILLE
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State | AR
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Zip | 72076-4386
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Country | US
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Telephone | 501-328-7515
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Fax | 501-328-7510
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Provider Business Mailing Address
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Address Line | 650 S SHACKLEFORD RD SUITE 217
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3522
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Country | US
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Telephone | 501-221-1843
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Fax | 501-221-2376
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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