Healthcare Provider Details

I. General information

NPI: 1114754561
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL KOCH LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7741 16TH AVE SW
SEATTLE WA
98106-1840
US

IV. Provider business mailing address

7741 16TH AVE SW
SEATTLE WA
98106-1840
US

V. Phone/Fax

Practice location:
  • Phone: 509-906-3429
  • Fax:
Mailing address:
  • Phone: 347-683-5272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMHCA.MC.61588761
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: