Provider Demographics
NPI:1346673027
Name:KOCH, NATHAN (NCC, CI, MS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:KOCH
Suffix:
Gender:M
Credentials:NCC, CI, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 WEST ESPLANADE AVENUE
Mailing Address - Street 2:600
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-831-8475
Mailing Address - Fax:
Practice Address - Street 1:3330 W ESPLANADE AVE S
Practice Address - Street 2:600
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3454
Practice Address - Country:US
Practice Address - Phone:504-831-8475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health