Provider Demographics
NPI:1396412359
Name:KOCH, LYNDEE (MS)
Entity type:Individual
Prefix:MRS
First Name:LYNDEE
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41471 ROAD 768
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-3465
Mailing Address - Country:US
Mailing Address - Phone:308-529-3058
Mailing Address - Fax:
Practice Address - Street 1:815 LAKE AVE
Practice Address - Street 2:
Practice Address - City:GOTHENBURG
Practice Address - State:NE
Practice Address - Zip Code:69138-1943
Practice Address - Country:US
Practice Address - Phone:308-537-3691
Practice Address - Fax:308-537-3062
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health