MEDICARE: ON THE COUCH LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1598391609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON THE COUCH LLC

Provider Business Mailing Address
First Line	:	136 BELROI PL
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-1600
Country	:	US
Telephone Number	:	248-403-8123
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 BELROI PL
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-1600
Country	:	US
Telephone Number	:	248-403-8123
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL THERAPIST
Name	:	MRS. KARIN B JOHNSON
Credential	:	LMSW
Telephone Number	:	248-403-8123

Provider Enumeration Date	:	03/20/2020
Last Update Date	:	12/06/2023

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Directions to “ON THE COUCH LLC ” Practice Location

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