Healthcare Provider Details

I. General information

NPI: 1386855831
Provider Name (Legal Business Name): LOUIS JAY KOCH LSCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 NICHOLS RD SUITE 251
KANSAS CITY MO
64112-2000
US

IV. Provider business mailing address

411 NICHOLS RD SUITE 251
KANSAS CITY MO
64112-2000
US

V. Phone/Fax

Practice location:
  • Phone: 816-561-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM0002911
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: