Provider Demographics
NPI:1730697244
Name:COUGHENOUR, TODD
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:COUGHENOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-1855
Mailing Address - Country:US
Mailing Address - Phone:540-459-6726
Mailing Address - Fax:540-459-6748
Practice Address - Street 1:600 N MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1855
Practice Address - Country:US
Practice Address - Phone:540-459-6726
Practice Address - Fax:540-459-6748
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool