Provider Demographics
NPI:1457377103
Name:KOCH, PATRICIA KRIEGEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:KRIEGEL
Last Name:KOCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 HAZEN LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-6362
Mailing Address - Country:US
Mailing Address - Phone:512-773-3923
Mailing Address - Fax:
Practice Address - Street 1:2206 HAZEN LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-6362
Practice Address - Country:US
Practice Address - Phone:512-773-3923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0963142-01Medicaid
TX0963142-01Medicaid