Provider Demographics
NPI:1649334897
Name:POCHE, RODNEY SCOTT (LMFT)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:SCOTT
Last Name:POCHE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936-0579
Mailing Address - Country:US
Mailing Address - Phone:928-337-4301
Mailing Address - Fax:
Practice Address - Street 1:470 W CLEVELAND
Practice Address - Street 2:
Practice Address - City:ST. JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936-0579
Practice Address - Country:US
Practice Address - Phone:928-337-4301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT10133106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ821258Medicaid