Provider Demographics
NPI:1992965313
Name:MOBILE PSYCHOLOGICAL, LLC
Entity type:Organization
Organization Name:MOBILE PSYCHOLOGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:251-479-8677
Mailing Address - Street 1:2411 OLD SHELL RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3019
Mailing Address - Country:US
Mailing Address - Phone:251-479-8677
Mailing Address - Fax:251-478-8097
Practice Address - Street 1:2411 OLD SHELL RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3019
Practice Address - Country:US
Practice Address - Phone:251-479-8677
Practice Address - Fax:251-478-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL198103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty