Provider Demographics
NPI:1043597446
Name:RUSSELL KOCH AND ASSOCIATES INC
Entity Type:Organization
Organization Name:RUSSELL KOCH AND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-928-2044
Mailing Address - Street 1:820 WALL ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069
Mailing Address - Country:US
Mailing Address - Phone:405-928-2044
Mailing Address - Fax:405-928-2049
Practice Address - Street 1:820 WALL ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6302
Practice Address - Country:US
Practice Address - Phone:405-928-2044
Practice Address - Fax:405-928-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK602103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty