=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548192230
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA KOCH LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2026
-----------------------------------------------------
Last Update Date | 05/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6060 N FOUNTAIN PLAZA DR STE 140
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85704-7874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-712-4600
-----------------------------------------------------
Fax | 602-428-7045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 20216
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85036-0216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-712-4600
-----------------------------------------------------
Fax | 602-428-7045
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LAC-18228
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------