Provider Demographics
NPI:1205634839
Name:BLACK COUCH THERAPY, LLC
Entity type:Organization
Organization Name:BLACK COUCH THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER; THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-424-5635
Mailing Address - Street 1:9152 TAYLORSVILLE RD # 266
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1752
Mailing Address - Country:US
Mailing Address - Phone:502-424-5635
Mailing Address - Fax:
Practice Address - Street 1:1860 MELLWOOD AVE # 194
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1033
Practice Address - Country:US
Practice Address - Phone:502-424-5635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7101053210Medicaid