Basic Information
| Provider Information | |||||||||
| NPI: | 1326350646 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COUCH | ||||||||
| FirstName: | FRANKIE | ||||||||
| MiddleName: | JOE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 N GABBART RD | ||||||||
| Address2: | |||||||||
| City: | STRINGTOWN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745699055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802392367 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 301 N HIGH ST | ||||||||
| Address2: | |||||||||
| City: | ANTLERS | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745232238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802985779 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2010 | ||||||||
| LastUpdateDate: | 07/02/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 100750190M | 05 | OK | MEDICAID |