Provider Demographics
NPI:1265978209
Name:KOCH, MELISSA (PLPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KOCH
Suffix:
Gender:
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 GRASSO PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-3107
Mailing Address - Country:US
Mailing Address - Phone:314-328-9228
Mailing Address - Fax:
Practice Address - Street 1:87 GRASSO PLZ # 325
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-3107
Practice Address - Country:US
Practice Address - Phone:314-566-9168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-14
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016012148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health