NPIMap

Organization Active NPI

Couch Counseling Center, LLC

  • Mental Health Counselor
  • Menasha, WI
National Provider Identifier
1467025965
Registry record updated Jul 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
COUCH COUNSELING CENTER, LLC
Practice address
806 Valley Rd Ste 13
Menasha, WI 54952-1012
Phone
(920) 872-7292
Fax
(920) 872-7066
NPI assigned
Jul 21, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2021

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

Authorized official

Name
Mrs. Derreka J Walton, LPCNPI 1104418318
Title
Owner/Professional Counselor
Phone
(920) 872-7292

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

806 Valley Rd Ste 13
Menasha, WI 54952-1012

Mailing address

806 Valley Rd Ste 13
Menasha, WI 54952-1012
Phone (920) 872-7292

Other identifiers 2

IdentifierTypeStateIssuer
1104418318OtherWIPRIVATE INSURANCE
1104418318MedicaidWI

National Provider Directory

National Provider Directory

Locations

806 Valley Rd
Ste 13
Menasha, WI 54952
Phone (920) 872-7292

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1626825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626825600000",
    "number": "1467025965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 VALLEY RD STE 13",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521012",
            "telephone_number": "920-872-7292",
            "fax_number": "920-872-7066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 VALLEY RD STE 13",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521012",
            "telephone_number": "920-872-7292",
            "fax_number": "920-872-7066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUCH COUNSELING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-21",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "DERREKA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PROFESSIONAL COUNSELOR",
        "authorized_official_telephone_number": "920-872-7292",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE INSURANCE",
            "identifier": "1104418318",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104418318",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Menasha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; 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.