Provider Demographics
NPI:1306210687
Name:KOCH, RICHARD (LMHC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:KOCH
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 N CRYSTAL LAKE DR APT 46
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5974
Mailing Address - Country:US
Mailing Address - Phone:863-398-7392
Mailing Address - Fax:
Practice Address - Street 1:5421 U.S. HWY 98 SOUTH
Practice Address - Street 2:
Practice Address - City:HIGHLAND CITY
Practice Address - State:FL
Practice Address - Zip Code:33846
Practice Address - Country:US
Practice Address - Phone:863-701-7373
Practice Address - Fax:863-701-0404
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health