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General NPI Number Information
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NPI Number | 1306210687
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Entity Type | Individual
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Provider Name | RICHARD KOCH L.M.H.C.
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Gender | Male
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Dates
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Enumeration Date | 11/24/2015
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 5421 U.S. HWY 98 SOUTH
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City | HIGHLAND CITY
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State | FL
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Zip | 33846
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Country | US
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Telephone | 863-701-7373
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Fax | 863-701-0404
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Provider Business Mailing Address
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Address Line | 1880 N CRYSTAL LAKE DR APT 46
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City | LAKELAND
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State | FL
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Zip | 33801-5974
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Country | US
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Telephone | 863-398-7392
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH13793
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License Number State | FL
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