Healthcare Provider Details

I. General information

NPI: 1699438457
Provider Name (Legal Business Name): ANDREW KOCH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 JUNIPER AVE APT 7
BOULDER CO
80304-2468
US

IV. Provider business mailing address

2616 JUNIPER AVE APT 7
BOULDER CO
80304-2468
US

V. Phone/Fax

Practice location:
  • Phone: 720-776-9924
  • Fax:
Mailing address:
  • Phone: 720-776-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0021828
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: