Healthcare Provider Details

I. General information

NPI: 1336854694
Provider Name (Legal Business Name): NICOLE KOCH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S UNIVERSITY AVE
MOUNT PLEASANT MI
48858-3147
US

IV. Provider business mailing address

421 S UNIVERSITY AVE
MOUNT PLEASANT MI
48858-3147
US

V. Phone/Fax

Practice location:
  • Phone: 616-617-5122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NCOLE KOCH
Title or Position: THERAPIST/OWNER
Credential:
Phone: 616-617-5122