Provider Demographics
NPI:1720279037
Name:KOCH, STEVEN P (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:P
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 1:270 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5414
Mailing Address - Country:US
Mailing Address - Phone:530-570-9185
Mailing Address - Fax:
Practice Address - Street 1:270 E 4TH ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5414
Practice Address - Country:US
Practice Address - Phone:530-570-9185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7491OtherPSYCHOLOGY LICENSE