Provider Demographics
NPI:1568727881
Name:TIMOTHY RICHARD KOCKLER, LLC
Entity Type:Organization
Organization Name:TIMOTHY RICHARD KOCKLER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-632-1445
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84771-0153
Mailing Address - Country:US
Mailing Address - Phone:435-632-1445
Mailing Address - Fax:435-986-2262
Practice Address - Street 1:1224 S RIVER RD
Practice Address - Street 2:BLDG B SUITE 221
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8285
Practice Address - Country:US
Practice Address - Phone:435-632-1445
Practice Address - Fax:435-986-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty