MEDICARE: LISA Y COUCH, PHD, PLLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1518588524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA Y COUCH, PHD, PLLC

Provider Business Mailing Address
First Line	:	539 W COMMERCE ST STE 2058
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-1953
Country	:	US
Telephone Number	:	469-474-1146
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 N GOLIAD ST
Second Line	:
City	:	ROCKWALL
State	:	TX
Zip	:	75087-2717
Country	:	US
Telephone Number	:	214-934-1499
Fax Number	:	972-323-3485

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. LISA Y COUCH
Credential	:	PHD
Telephone Number	:	469-474-1146

Provider Enumeration Date	:	04/30/2020
Last Update Date	:	06/25/2024

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