Individual
CHARLES A KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LP
Contact information
Practice address
6900 78TH AVE N, BROOKLYN PARK, MN 55445-2719
(763) 560-4412
Mailing address
3300 TERRACE LN, GOLDEN VALLEY, MN 55422-3844
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1250
MN
Other
Enumeration date
12/05/2006
Last updated
07/08/2007
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