Provider Demographics
NPI:1073392981
Name:KOEHN, CLARIE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLARIE
Middle Name:J
Last Name:KOEHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 OAK ST STE 201
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2714
Mailing Address - Country:US
Mailing Address - Phone:816-235-5186
Mailing Address - Fax:
Practice Address - Street 1:5110 OAK ST STE 201
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2714
Practice Address - Country:US
Practice Address - Phone:816-235-5186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023036588103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling