Provider Demographics
NPI:1407500978
Name:COUCH, ASHLEY RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RENEE
Last Name:COUCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:RENEE
Other - Last Name:LACHANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:122 HICKORY CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8061
Mailing Address - Country:US
Mailing Address - Phone:754-800-3261
Mailing Address - Fax:
Practice Address - Street 1:710 OAKFIELD DR STE 206
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4954
Practice Address - Country:US
Practice Address - Phone:754-800-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW180761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical