Healthcare Provider Details

I. General information

NPI: 1841301595
Provider Name (Legal Business Name): ANNA M. KOCH PH.D., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6533 DESERT SPIRIT RD NW
ALBUQUERQUE NM
87114-6110
US

IV. Provider business mailing address

6533 DESERT SPIRIT RD NW
ALBUQUERQUE NM
87114-6110
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-5301
  • Fax:
Mailing address:
  • Phone: 505-585-5301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0182801
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: