Healthcare Provider Details

I. General information

NPI: 1336361054
Provider Name (Legal Business Name): KIRA KOCH-LARSEN LMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 N GRANT ST SUITE D
LEXINGTON NE
68850-1946
US

IV. Provider business mailing address

PO BOX 918
LEXINGTON NE
68850-0918
US

V. Phone/Fax

Practice location:
  • Phone: 308-324-3785
  • Fax: 308-324-5800
Mailing address:
  • Phone: 308-324-3785
  • Fax: 308-324-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number329
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: