Provider Demographics
NPI:1841301595
Name:KOCH, ANNA M (PHD, LPCC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:KOCH
Suffix:
Gender:F
Credentials:PHD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6533 DESERT SPIRIT RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6110
Mailing Address - Country:US
Mailing Address - Phone:505-585-5301
Mailing Address - Fax:
Practice Address - Street 1:6533 DESERT SPIRIT RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6110
Practice Address - Country:US
Practice Address - Phone:505-585-5301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0182801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080829226Medicaid
NM65000862Medicaid
NE838965-000OtherMAGELLAN MIS