Psychology Center of Russellville, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

12-01P Issued in AR

Legal business name

PSYCHOLOGY CENTER OF RUSSELLVILLE, LLC

Practice address

2621 W Main St
Suite 7
Russellville, AR 72801-2534

Phone

(479) 219-5041

Fax

(479) 219-5046

NPI assigned

Jun 12, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Christina Lin Couch, PSYD

Title

Owner

Phone

(479) 219-5041

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434067200000",
    "number": "1194106476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 W MAIN ST",
            "address_2": "SUITE 7",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012534",
            "telephone_number": "479-219-5041",
            "fax_number": "479-219-5046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 W MAIN ST",
            "address_2": "SUITE 7",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012534",
            "telephone_number": "479-219-5041",
            "fax_number": "479-219-5046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGY CENTER OF RUSSELLVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-12",
        "last_updated": "2015-06-12",
        "status": "A",
        "authorized_official_last_name": "COUCH",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_middle_name": "LIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-219-5041",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "AR",
            "license": "12-01P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "191430719",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Regina D Prince, CRNA
• Professional Christian Counseling Inc
• Benjamin Protheroe
• Charise Pruitt, CASE MANAGER PARAPRO
• Psychiatric Clinic PA
• Judith Puckett
• Mary Annette Pugh, MD
• Pultro & Palmer, P. a.
• Dana Pumphrey, RBT
• Wendy Michelle Pyburn, APRN FNP-C

• Clinical Psychologist in Russellville, AR
• Providers in Russellville, AR by specialty
• Clinical Psychologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.