| Timothy Richard Kockler, Llc | |
|
1224 S River Rd Bldg B Suite 221 St George UT 84790-8285 | |
| (435) 632-1445 | |
| (435) 986-2262 |
| Full Name | Timothy Richard Kockler, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1224 S River Rd, St George, Utah |
| Authorized Official Name and Position | Christina Kockler (RECEPTIONIST) |
| Authorized Official Contact | 4356321445 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Timothy Richard Kockler, Llc Po Box 153 St George UT 84771-0153 Ph: (435) 632-1445 | Timothy Richard Kockler, Llc 1224 S River Rd Bldg B Suite 221 St George UT 84790-8285 Ph: (435) 632-1445 |
| NPI Number | 1568727881 |
|---|---|
| Provider Enumeration Date | 07/12/2012 |
| Last Update Date | 07/12/2012 |
| Medicare PECOS PAC ID | 0749446821 |
|---|---|
| Medicare Enrollment ID | O20120717000486 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568727881 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Timothy R Kockler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063422202 PECOS PAC ID: 7719914175 Enrollment ID: I20050718001051 |
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