Healthcare Provider Details

I. General information

NPI: 1033564570
Provider Name (Legal Business Name): JOHN F KOCH M.A., LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13642 103RD AVE NE
KIRKLAND WA
98034-2045
US

IV. Provider business mailing address

13642 103RD AVE NE
KIRKLAND WA
98034-2045
US

V. Phone/Fax

Practice location:
  • Phone: 425-273-6379
  • Fax:
Mailing address:
  • Phone: 425-273-6379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60634995
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: