Provider Demographics
NPI:1821082769
Name:KOCH, LYNN A (LCSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:A
Last Name:KOCH
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 LAKE PLAZA DR
Mailing Address - Street 2:SUITE A106
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4061
Mailing Address - Country:US
Mailing Address - Phone:317-845-0266
Mailing Address - Fax:317-845-9255
Practice Address - Street 1:6801 LAKE PLAZA DR
Practice Address - Street 2:SUITE A106
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4061
Practice Address - Country:US
Practice Address - Phone:317-845-0266
Practice Address - Fax:317-845-9255
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002678A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000183583OtherANTHEM
IN264930Medicare ID - Type Unspecified