Healthcare Provider Details

I. General information

NPI: 1124319231
Provider Name (Legal Business Name): STEVEN KOCH M.A., LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 15TH ST SUITE C
LOS ALAMOS NM
87544-3000
US

IV. Provider business mailing address

1505 15TH ST SUITE C
LOS ALAMOS NM
87544-3000
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-3264
  • Fax: 505-662-9707
Mailing address:
  • Phone: 505-662-3264
  • Fax: 505-662-9707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0165781
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: