Provider Demographics
NPI:1124319231
Name:KOCH, STEVEN (MA, LPCC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:KOCH
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 15TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-3000
Mailing Address - Country:US
Mailing Address - Phone:505-662-3264
Mailing Address - Fax:505-662-9707
Practice Address - Street 1:1505 15TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3000
Practice Address - Country:US
Practice Address - Phone:505-662-3264
Practice Address - Fax:505-662-9707
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0165781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09727523Medicaid