Provider Demographics
NPI:1831473768
Name:KOCH, JAYLYNNE S (PHD, LPC, RPT-S)
Entity Type:Individual
Prefix:DR
First Name:JAYLYNNE
Middle Name:S
Last Name:KOCH
Suffix:
Gender:F
Credentials:PHD, LPC, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 ALLYN WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-4227
Mailing Address - Country:US
Mailing Address - Phone:719-214-9393
Mailing Address - Fax:
Practice Address - Street 1:4390 N ACADEMY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6657
Practice Address - Country:US
Practice Address - Phone:719-357-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional