Provider Demographics
NPI:1437501913
Name:KOCH, STEPHANIE (LPCC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 EAST RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-4301
Mailing Address - Country:US
Mailing Address - Phone:505-412-7756
Mailing Address - Fax:
Practice Address - Street 1:195 EAST RD STE 104
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4301
Practice Address - Country:US
Practice Address - Phone:505-412-7756
Practice Address - Fax:505-662-8859
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0202931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health