Provider Demographics
NPI:1083228993
Name:KOEN, GALEN SCOTT
Entity Type:Individual
Prefix:
First Name:GALEN
Middle Name:SCOTT
Last Name:KOEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 OCCIDENTAL DR APT 17
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2441
Mailing Address - Country:US
Mailing Address - Phone:805-200-9566
Mailing Address - Fax:
Practice Address - Street 1:955 E THOMPSON BLVD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3008
Practice Address - Country:US
Practice Address - Phone:805-641-9001
Practice Address - Fax:805-641-9040
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14212101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)