Healthcare Provider Details

I. General information

NPI: 1346594546
Provider Name (Legal Business Name): JULIE KOCH PH.D., LHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 WILLARD HALL
STILLWATER OK
74078-1001
US

IV. Provider business mailing address

219 E ROGERS DR
STILLWATER OK
74075-1623
US

V. Phone/Fax

Practice location:
  • Phone: 405-744-3155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1133
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: