Individual
GILLIAN CLARE KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
900 LONG LAKE RD STE 160, NEW BRIGHTON, MN 55112-6414
(612) 706-9630
Mailing address
1381 RANDOLPH AVE, SAINT PAUL, MN 55105-2558
(813) 433-3454
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2219
MN
Other
Enumeration date
04/25/2017
Last updated
10/25/2019
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