Provider Demographics
NPI:1518754043
Name:KOCH, JOSHUA WAYDE (MFT INTERN)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:WAYDE
Last Name:KOCH
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 NE 2ND CT
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-2507
Mailing Address - Country:US
Mailing Address - Phone:209-765-7255
Mailing Address - Fax:
Practice Address - Street 1:753 N 35TH ST STE 208D
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8870
Practice Address - Country:US
Practice Address - Phone:206-588-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program