NPIMap

Organization Active NPI

Jennifer Koch, Psy.D., PLLC

Doing business as Bloom and Blossom Wellness Spa

  • Psychologist
  • Tumwater, WA
National Provider Identifier
1184355562
Registry record updated Jul 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
JENNIFER KOCH, PSY.D., PLLC
Doing business as
Bloom and Blossom Wellness Spa
Practice address
111 Tumwater Blvd SE Ste C213
Tumwater, WA 98501-6400
Phone
(360) 706-2674
Fax
(360) 634-3565
NPI assigned
Jun 17, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jennifer Koch, PSY.D.NPI 1407194970
Title
Psychologist/Owner
Phone
(360) 706-2674

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

111 Tumwater Blvd SE Ste C213
Tumwater, WA 98501-6400

Mailing address

111 Tumwater Blvd SE Ste C213
Tumwater, WA 98501-6400
Phone (360) 706-2674

Other names 1

  • Bloom and Blossom Wellness Spa Doing business as

National Provider Directory

National Provider Directory

Locations

111 Tumwater Blvd SE
Ste C213
Tumwater, WA 98501
Phone (360) 706-2674

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656633600000",
    "number": "1184355562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 TUMWATER BLVD SE STE C213",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985016400",
            "telephone_number": "360-706-2674",
            "fax_number": "360-634-3565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 TUMWATER BLVD SE STE C213",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985016400",
            "telephone_number": "360-706-2674",
            "fax_number": "360-634-3565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER KOCH, PSY.D., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-17",
        "last_updated": "2022-07-01",
        "certification_date": "2022-07-01",
        "status": "A",
        "authorized_official_last_name": "KOCH",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "360-706-2674",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloom and Blossom Wellness Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tumwater, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.