Healthcare Provider Details

I. General information

NPI: 1518754043
Provider Name (Legal Business Name): JOSHUA WAYDE KOCH MFT INTERN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 N 35TH ST STE 208D
SEATTLE WA
98103-8870
US

IV. Provider business mailing address

2424 NE 2ND CT
BATTLE GROUND WA
98604-2507
US

V. Phone/Fax

Practice location:
  • Phone: 206-588-5386
  • Fax:
Mailing address:
  • Phone: 209-765-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: