Individual
DR. GARY KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
500 MARKET ST STE 204B, BEAVER, PA 15009
(724) 728-6670
(724) 728-5570
Mailing address
500 MARKET ST STE 204B, BEAVER, PA 15009-2998
(724) 728-6670
(724) 728-5570
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PS018065
PA
103TS0200X
School Psychologist
PS018065
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1032369400002
—
PA
Enumeration date
07/21/2016
Last updated
07/21/2018
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