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General NPI Number Information
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NPI Number | 1235635558
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Entity Type | Individual
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Provider Name | LYDIA JANE KOCH LPC
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Gender | Female
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 35037 ROYAL PL
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City | SOLDOTNA
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State | AK
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Zip | 99669-9755
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Country | US
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Telephone | 907-299-8871
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 369
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City | ANCHOR POINT
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State | AK
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Zip | 99556-0369
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Country | US
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Telephone | 907-299-7781
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 187965
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License Number State | AK
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