Provider Demographics
NPI:1316637275
Name:PINK COUCH WELLNESS
Entity type:Organization
Organization Name:PINK COUCH WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-380-6516
Mailing Address - Street 1:1220 NE STATION XING STE 114
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-8013
Mailing Address - Country:US
Mailing Address - Phone:515-680-6516
Mailing Address - Fax:
Practice Address - Street 1:1220 NE STATION XING STE 114
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-8013
Practice Address - Country:US
Practice Address - Phone:515-680-6516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty