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General NPI Number Information
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NPI Number | 1841148194
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Entity Type | Organization
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Legal Business Name | RED COUCH CHILD AND INDIVIDUAL THERAPY INC
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Dates
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Enumeration Date | 03/20/2026
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 10620 TREENA ST STE 230
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City | SAN DIEGO
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State | CA
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Zip | 92131-1140
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Country | US
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Telephone | 858-252-5150
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Fax | 858-999-2537
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Provider Business Mailing Address
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Address Line | 10620 TREENA ST STE 230
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City | SAN DIEGO
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State | CA
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Zip | 92131-1140
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Country | US
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Telephone | 858-252-5150
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Fax | 858-999-2537
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | MS. JACIE WILCOCK
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Credential | LMFT
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Telephone | 208-869-2393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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