Healthcare Provider Details

I. General information

NPI: 1295876506
Provider Name (Legal Business Name): LYNNE HALL KOCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 BROADWAY ST
NEW ORLEANS LA
70125-4131
US

IV. Provider business mailing address

2503 BROADWAY ST
NEW ORLEANS LA
70125-4131
US

V. Phone/Fax

Practice location:
  • Phone: 504-866-6271
  • Fax: 504-861-4257
Mailing address:
  • Phone: 504-866-6271
  • Fax: 504-861-4257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4939
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: