Healthcare Provider Details

I. General information

NPI: 1407904022
Provider Name (Legal Business Name): MELISSA MARIE KOCH LMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 COURT ST
BEATRICE NE
68310-3926
US

IV. Provider business mailing address

1708 PLEASANT VIEW AVE
BEATRICE NE
68310-1740
US

V. Phone/Fax

Practice location:
  • Phone: 402-223-3843
  • Fax: 402-223-4200
Mailing address:
  • Phone: 402-228-7289
  • Fax: 402-223-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2201
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: