Charles A Koch, MA, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1250 Issued in MN

Practice address

6900 78TH Ave N
Brooklyn Park, MN 55445-2719

Phone

(763) 560-4412

NPI assigned

Dec 5, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Planned Parenthood Minnesota, North Dakota, South Dakota

  • Non-Surgical Family Planning Clinic/Center
  • Saint Paul, MN
  • NPI 1629057146
  NPD (past)
• The Family Partnership

  • Community/Behavioral Health Agency
  • Minneapolis, MN
  • NPI 1487708616
  NPD (past)

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346308038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 TERRACE LN",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554223844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 78TH AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554452719",
            "telephone_number": "763-560-4412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOCH",
        "first_name": "CHARLES",
        "middle_name": "A",
        "credential": "MA, LP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "1250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kiz Home Health Care LLC
• Erin Mackenzie Klukas, OD
• Madalyn Marie Knase, PA-C
• Knutson Counseling Clinic
• Josan Wai-Tak Ko, O.D.
• Rita M. Koelman X, LPCC
• Jenneh Koenig, LPN
• Kole Transportation
• Ishmael Komara
• William J Konz, PHARMD

• Psychologist in Brooklyn Park, MN
• Providers in Brooklyn Park, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.