Individual
MR. BRYAN MATHEW KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
250 WASHBURN AVE, CAPITOLA, CA 95010-3730
(831) 464-5660
Mailing address
250 WASHBURN AVE, CAPITOLA, CA 95010-3730
(831) 464-5660
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
CA
1041C0700X
Clinical Social Worker
ASW123657
CA
1041S0200X
School Social Worker
200091184
CA
Other
Enumeration date
02/10/2025
Last updated
02/10/2025
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