Healthcare Provider Details

I. General information

NPI: 1518483577
Provider Name (Legal Business Name): MARIA A KOCH BALDRIDGE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MARIA A KOCH

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W EADS PKWY
LAWRENCEBURG IN
47025-1374
US

IV. Provider business mailing address

401 W EADS PKWY STE 450
LAWRENCEBURG IN
47025-1376
US

V. Phone/Fax

Practice location:
  • Phone: 513-846-2482
  • Fax:
Mailing address:
  • Phone: 812-537-7375
  • Fax: 813-537-5257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004347A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: