Individual
ZACKERY KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA, MAADAC-I
Contact information
Practice address
302 W JACKSON ST, BOLIVAR, MO 65613-1931
(417) 410-7474
Mailing address
302 W JACKSON ST, BOLIVAR, MO 65613-1931
(417) 410-7474
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11936
MO
Other
Enumeration date
08/09/2019
Last updated
08/09/2019
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