Healthcare Provider Details

I. General information

NPI: 1538891510
Provider Name (Legal Business Name): KALEN KOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S STEELE ST STE 435
DENVER CO
80209-2805
US

IV. Provider business mailing address

99 E ARIZONA AVE APT 1359
DENVER CO
80210-2304
US

V. Phone/Fax

Practice location:
  • Phone: 917-809-7297
  • Fax:
Mailing address:
  • Phone: 904-248-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: