Provider Demographics
NPI:1417045220
Name:KOINER, CHARLOTTE A
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:A
Last Name:KOINER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21714 HARDY OAK BLVD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4838
Mailing Address - Country:US
Mailing Address - Phone:210-490-9062
Mailing Address - Fax:210-490-8843
Practice Address - Street 1:21714 HARDY OAK BLVD
Practice Address - Street 2:SUITE #104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4838
Practice Address - Country:US
Practice Address - Phone:210-490-9062
Practice Address - Fax:210-490-8843
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12672101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84441LOtherBLUECROSS/BLUESHIELDOF TX