Individual
NICOLE ANNE KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPCC
Contact information
Practice address
11117 ZEALAND AVE N, CHAMPLIN, MN 55316-3595
(763) 746-0842
Mailing address
235 MALLARD LN, LORETTO, MN 55357-9563
(763) 286-7138
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CC02437
MN
101YP2500X
Professional Counselor
Primary
2437
MN
Other
Enumeration date
04/10/2020
Last updated
10/11/2022
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