Healthcare Provider Details

I. General information

NPI: 1265978209
Provider Name (Legal Business Name): MELISSA KOCH PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2017
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 GRASSO PLZ # 325
SAINT LOUIS MO
63123-3107
US

IV. Provider business mailing address

87 GRASSO PLZ
SAINT LOUIS MO
63123-3107
US

V. Phone/Fax

Practice location:
  • Phone: 314-566-9168
  • Fax:
Mailing address:
  • Phone: 314-328-9228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2016012148
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: