Provider Demographics
NPI:1932455490
Name:COUTCHER, MICHELLE (LISW-S)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:COUTCHER
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2739 NAVARRE AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3277
Mailing Address - Country:US
Mailing Address - Phone:567-298-4640
Mailing Address - Fax:567-298-4641
Practice Address - Street 1:2739 NAVARRE AVE STE 302
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3277
Practice Address - Country:US
Practice Address - Phone:567-298-4640
Practice Address - Fax:567-298-4641
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.12009851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0080532Medicaid
OHH169660OtherMEDICARE PTAN