Individual
RANDALL KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
704 EMMET ST, PETOSKEY, MI 49770-2910
(231) 347-5511
Mailing address
704 EMMET ST, PETOSKEY, MI 49770-2910
(231) 347-5511
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
180.005305
IL
101YP2500X
Professional Counselor
Primary
6401012477
MI
Other
Enumeration date
02/11/2014
Last updated
02/11/2014
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