Provider Demographics
NPI:1477751618
Name:RICHARD KOCH COUNSELING SERVICES
Entity Type:Organization
Organization Name:RICHARD KOCH COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:574-266-5700
Mailing Address - Street 1:501 W BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2964
Mailing Address - Country:US
Mailing Address - Phone:574-266-5700
Mailing Address - Fax:574-266-6101
Practice Address - Street 1:501 W BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2964
Practice Address - Country:US
Practice Address - Phone:574-266-5700
Practice Address - Fax:574-266-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002921251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN184080Medicare PIN