MEDICARE: THE KIDS' COUCH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PC-0000362	DE

General Provider Information

NPI Number	:	1417992587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE KIDS' COUCH, INC.

Provider Business Mailing Address
First Line	:	240 N JAMES ST
Second Line	:	SUITE 200
City	:	WILMINGTON
State	:	DE
Zip	:	19804-3169
Country	:	US
Telephone Number	:	302-633-0301
Fax Number	:	302-633-0331

Provider Business Practice Location Address
First Line	:	240 N JAMES ST
Second Line	:	SUITE 200
City	:	WILMINGTON
State	:	DE
Zip	:	19804-3169
Country	:	US
Telephone Number	:	302-633-0301
Fax Number	:	302-633-0331

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. OLGA YATZUS
Credential	:	LPCMH
Telephone Number	:	302-633-0301

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	12/30/2016

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