Individual
MACKENZIE W COUCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS,BCBA
Contact information
Practice address
4500 SATELLITE BLVD STE 2250, DULUTH, GA 30096-5047
(800) 381-2195
(888) 381-0822
Mailing address
4500 SATELLITE BLVD STE 2250, DULUTH, GA 30096-5047
(800) 381-2195
(888) 381-0822
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-32004
TN
Other
Enumeration date
06/17/2019
Last updated
06/17/2019
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