MEDICARE: SOPHIA C COUCH APCC

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	APCC11800	CA

General Provider Information

NPI Number	:	1801520481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA C COUCH APCC

Provider Business Mailing Address
First Line	:	4212 CLEVELAND AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2413
Country	:	US
Telephone Number	:	408-806-5458
Fax Number	:

Provider Business Practice Location Address
First Line	:	5920 FRIARS RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1076
Country	:	US
Telephone Number	:	619-728-4177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2022
Last Update Date	:	01/12/2026

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Directions to “ SOPHIA C COUCH APCC” Practice Location

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