Healthcare Provider Details

I. General information

NPI: 1174650097
Provider Name (Legal Business Name): ANDREA KATHLEEN KOCHER MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 FRONT ST
SAN DIEGO CA
92103-3019
US

IV. Provider business mailing address

3821 FRONT ST
SAN DIEGO CA
92103-3019
US

V. Phone/Fax

Practice location:
  • Phone: 619-806-3681
  • Fax: 619-294-3225
Mailing address:
  • Phone: 619-806-3681
  • Fax: 619-294-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number36255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: