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NPI Code Detail

MEDICARE: DR. KRISTEN HEATHER KOTH LPC

MEDICARE: DR. KRISTEN HEATHER KOTH LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor011784GA

General Provider Information

NPI Number : 1427715085
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTEN HEATHER KOTH LPC
Provider Business Mailing Address
First Line : 3044 BRIARCLIFF RD NE APT 7
Second Line :
City : ATLANTA
State : GA
Zip : 30329-2619
Country : US
Telephone Number : 404-805-9755
Fax Number :
Provider Business Practice Location Address
First Line : 3754 LAVISTA RD STE 200
Second Line :
City : TUCKER
State : GA
Zip : 30084-5627
Country : US
Telephone Number : 470-344-6551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2021
Last Update Date : 11/18/2021

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