Provider Demographics
NPI:1699438457
Name:KOCH, ANDREW (MA, LPCC, NLC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:KOCH
Suffix:
Gender:M
Credentials:MA, LPCC, NLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 JUNIPER AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2468
Mailing Address - Country:US
Mailing Address - Phone:970-480-7796
Mailing Address - Fax:
Practice Address - Street 1:4710 TABLE MESA DR STE B
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-4504
Practice Address - Country:US
Practice Address - Phone:720-776-9924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0021828101Y00000X
CO0018775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor