1831109776 NPI number — KATHLEEN G. KOEHLER LCP-LMFT

Table of content: KATHLEEN G. KOEHLER LCP-LMFT (NPI 1831109776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831109776 NPI number — KATHLEEN G. KOEHLER LCP-LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOEHLER
Provider First Name:
KATHLEEN
Provider Middle Name:
G.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCP-LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831109776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3030 NACOGDOCHES RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78217-4540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-826-9599
Provider Business Mailing Address Fax Number:
210-826-9828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3030 NACOGDOCHES RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78217-4540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-826-9599
Provider Business Practice Location Address Fax Number:
210-826-9828
Provider Enumeration Date:
08/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  10193 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 000772-028580 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)