Provider Demographics
NPI:1467462853
Name:KOCH, DENNIS G (LMHC)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:G
Last Name:KOCH
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11552 VOGT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-6643
Mailing Address - Country:US
Mailing Address - Phone:352-465-5025
Mailing Address - Fax:352-465-5027
Practice Address - Street 1:11552 VOGT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34431-6643
Practice Address - Country:US
Practice Address - Phone:352-465-5025
Practice Address - Fax:352-465-5027
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMHC 6972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health