Healthcare Provider Details

I. General information

NPI: 1598729121
Provider Name (Legal Business Name): CYNTHIA L KOCHIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NORTH THIRD SUITE B
MARQUETTE MI
49855
US

IV. Provider business mailing address

316 E MICHIGAN
MARQUETTE MI
49855
US

V. Phone/Fax

Practice location:
  • Phone: 906-226-1410
  • Fax:
Mailing address:
  • Phone: 906-226-1410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301010191
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: