Individual
BENJAMIN KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
3840 HULEN ST, HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76107-7277
(817) 569-4300
Mailing address
PO BOX 2603, HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76113-2603
(817) 569-4300
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
52810
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300673601
—
TX
01
—
88826Q
BCBS
TX
Enumeration date
02/14/2012
Last updated
11/16/2012
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