Healthcare Provider Details

I. General information

NPI: 1619008331
Provider Name (Legal Business Name): BROOKE C. KOCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 E 3RD ST
CHATTANOOGA TN
37403-2107
US

IV. Provider business mailing address

3733 FREDRICK ST
CHATTANOOGA TN
37410-1233
US

V. Phone/Fax

Practice location:
  • Phone: 423-266-6751
  • Fax: 423-763-4662
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC2214
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: