1518483577 NPI number — MARIA A KOCH BALDRIDGE LMHC

Table of content: MARIA A KOCH BALDRIDGE LMHC (NPI 1518483577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518483577 NPI number — MARIA A KOCH BALDRIDGE LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALDRIDGE
Provider First Name:
MARIA
Provider Middle Name:
A KOCH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOCH
Provider Other First Name:
MARIA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518483577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 W EADS PKWY STE 450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEBURG
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47025-1376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-537-7375
Provider Business Mailing Address Fax Number:
813-537-5257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 W EADS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47025-1374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-846-2482
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 39004347A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 610661458 . This is a "TAX ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".