Provider Demographics
NPI:1790022960
Name:KOECH, MIRIAM A
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:A
Last Name:KOECH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:A
Other - Last Name:TYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:490 N I 35 E
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205
Mailing Address - Country:US
Mailing Address - Phone:940-369-5373
Mailing Address - Fax:
Practice Address - Street 1:490 N I 35 E
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205
Practice Address - Country:US
Practice Address - Phone:940-369-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst