Provider Demographics
NPI:1063651412
Name:KOINONIA CHRISTIAN COUNSELING, P.A.
Entity Type:Organization
Organization Name:KOINONIA CHRISTIAN COUNSELING, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:940-783-8135
Mailing Address - Street 1:1307 BALLYCASTLE LN
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0084
Mailing Address - Country:US
Mailing Address - Phone:940-783-8135
Mailing Address - Fax:940-539-3185
Practice Address - Street 1:6021 MORRISS RD
Practice Address - Street 2:SUITE 109A
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3710
Practice Address - Country:US
Practice Address - Phone:940-783-8135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201140251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health