Healthcare Provider Details

I. General information

NPI: 1679770184
Provider Name (Legal Business Name): DEANNA S. KOCH M.A., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 44TH ST
PITTSBURGH PA
15201-3038
US

IV. Provider business mailing address

55 SAMPSON ST
PITTSBURGH PA
15205-2053
US

V. Phone/Fax

Practice location:
  • Phone: 412-235-1985
  • Fax:
Mailing address:
  • Phone: 412-400-9160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004210
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: