Basic Information
| Provider Information | |||||||||
| NPI: | 1083770333 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COUTCHER | ||||||||
| FirstName: | JUANITA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 COMMUNITY | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647358804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608908186 | ||||||||
| FaxNumber: | 6608908186 | ||||||||
| Practice Location | |||||||||
| Address1: | 1091 MIDWAY DR | ||||||||
| Address2: | |||||||||
| City: | LINN CREEK | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650521687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733466758 | ||||||||
| FaxNumber: | 5733460621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 12/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2459 | LA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 2009012566 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.