Provider Demographics
NPI:1033341334
Name:KOCH, DAVID T (LPC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:KOCH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 EXECUTIVE PARKWAY DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6323
Mailing Address - Country:US
Mailing Address - Phone:314-469-5522
Mailing Address - Fax:314-469-5504
Practice Address - Street 1:1023 EXECUTIVE PARKWAY DR
Practice Address - Street 2:SUITE 10
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6323
Practice Address - Country:US
Practice Address - Phone:314-469-5522
Practice Address - Fax:314-469-5504
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007012314101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional