Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003129636 |
---|---|
Provider Name | Mr. Adam David Couch |
First Address | Eugene, OR 97402-3758 |
Second Address | Eugene, OR 97401-5306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2010 |
Last Update Date | 24/07/2010 |