Provider Demographics
NPI:1205196011
Name:KOCH, KRISTA CHARLOTTA
Entity Type:Individual
Prefix:MISS
First Name:KRISTA
Middle Name:CHARLOTTA
Last Name:KOCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E PLUMB LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3536
Mailing Address - Country:US
Mailing Address - Phone:775-825-5822
Mailing Address - Fax:
Practice Address - Street 1:620 E PLUMB LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3536
Practice Address - Country:US
Practice Address - Phone:775-825-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health