| Doctor Name: | KATHLEEN WIRTH-COUCH |
| NPI Number: | 1508224825 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | |
| Business Practice Address: | 604 W Dianne Ln Mahomet, IL - 618539147 |
| Business Phone Number: | 2173696048 |
| Business Fax Number: | |
| Mailing Address: | Po Box 271, MAHOMET |
| State: | IL |
| Postal Code: | 618530271 |
| Phone Number: | 2173696048 |
| Fax Number: | |
| NPI Enumeration Date: | 02/01/2016 |
| NPI Last Update Date: | 02/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YS0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |