Provider Demographics
NPI:1689411720
Name:COUCH, LILY (RD, LD)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:COUCH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 WALNUT ST APT 304
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-8037
Mailing Address - Country:US
Mailing Address - Phone:734-347-3629
Mailing Address - Fax:
Practice Address - Street 1:1309 WALNUT ST APT 304
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-8037
Practice Address - Country:US
Practice Address - Phone:734-347-3629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86153481133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered