Provider Demographics
NPI:1649324229
Name:KOCH, SHELLY DEE (MA LPC)
Entity type:Individual
Prefix:MISS
First Name:SHELLY
Middle Name:DEE
Last Name:KOCH
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:917 SCOTTISH CT
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1809
Mailing Address - Country:US
Mailing Address - Phone:717-972-4793
Mailing Address - Fax:717-972-4172
Practice Address - Street 1:503 N 21ST ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2204
Practice Address - Country:US
Practice Address - Phone:717-972-4793
Practice Address - Fax:717-972-4172
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPC004157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional