Provider Demographics
NPI:1063422202
Name:KOCKLER, TIM R (PHD)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:R
Last Name:KOCKLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790
Mailing Address - Country:US
Mailing Address - Phone:435-632-1445
Mailing Address - Fax:435-688-1091
Practice Address - Street 1:1224 S. RIVER ROAD
Practice Address - Street 2:SUITE 221
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-632-1445
Practice Address - Fax:435-688-1091
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174673648103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT006902025Medicare PIN