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NPI Code Detail

MEDICARE: JASON K KOCH PSYD

MEDICARE: JASON K KOCH PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist1989SC

General Provider Information

NPI Number : 1245752245
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON K KOCH PSYD
Provider Business Mailing Address
First Line : 573 POLARIS WAY
Second Line :
City : SUMMERVILLE
State : SC
Zip : 29486-2476
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 109 BEE ST
Second Line :
City : CHARLESTON
State : SC
Zip : 29401-5703
Country : US
Telephone Number : 843-577-5011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2017
Last Update Date : 06/06/2026

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