Provider Demographics
NPI:1437118759
Name:KOCH, ANNE L (LCPC)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:L
Last Name:KOCH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 FOREST AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103
Mailing Address - Country:US
Mailing Address - Phone:207-874-2884
Mailing Address - Fax:207-536-0176
Practice Address - Street 1:778 FOREST AVENUE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103
Practice Address - Country:US
Practice Address - Phone:207-874-2884
Practice Address - Fax:207-775-3007
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1309101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME132060101Medicaid
ME132060100Medicaid