Provider Demographics
NPI:1326256496
Name:KOENIG, ELWOOD RAY (WOODY KOENIG LCSW)
Entity Type:Individual
Prefix:MR
First Name:ELWOOD
Middle Name:RAY
Last Name:KOENIG
Suffix:
Gender:M
Credentials:WOODY KOENIG LCSW
Other - Prefix:MR
Other - First Name:WOODY
Other - Middle Name:
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:WOODY KOENIG LCSW
Mailing Address - Street 1:PO BOX 1546
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-3546
Mailing Address - Country:US
Mailing Address - Phone:541-567-3363
Mailing Address - Fax:
Practice Address - Street 1:319 W LOCUST AVE
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1734
Practice Address - Country:US
Practice Address - Phone:541-567-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL1262101YM0800X
WALW00006625101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR83124000OtherBCBS REGENCE INSURANCE