Individual
ISABELLE MEGAN COUCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 234-9591
Mailing address
6007 SW KARLA CT, PORTLAND, OR 97239-1187
(650) 678-3552
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/26/2022
Last updated
08/26/2022
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