Provider Demographics
NPI:1790805661
Name:KOCH, DAVID ALLAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLAN
Last Name:KOCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DESTA DR
Mailing Address - Street 2:SUITE 3340
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-5520
Mailing Address - Country:US
Mailing Address - Phone:432-684-8113
Mailing Address - Fax:432-570-5035
Practice Address - Street 1:6 DESTA DR
Practice Address - Street 2:SUITE 3340
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-5520
Practice Address - Country:US
Practice Address - Phone:432-684-8113
Practice Address - Fax:432-570-5035
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT22225103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical