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NPI Code Detail

MEDICARE: JESSICA KOH M.A.

MEDICARE: JESSICA KOH M.A.
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
1101YP2500XProfessional Counselor20703AZ
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1780129981
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA KOH M.A.
Provider Business Mailing Address
First Line : 11201 N TATUM BLVD STE 300
Second Line : #912020
City : PHOENIX
State : AZ
Zip : 85028-6039
Country : US
Telephone Number : 206-658-7951
Fax Number :
Provider Business Practice Location Address
First Line : 11201 N TATUM BLVD STE 300
Second Line : #912020
City : PHOENIX
State : AZ
Zip : 85028-6039
Country : US
Telephone Number : 623-252-9118
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2016
Last Update Date : 07/25/2025

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