Provider Demographics
NPI:1477216067
Name:KOLLER, ADRIENNE M (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:M
Last Name:KOLLER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 THORPE LN, STE 105
Mailing Address - Street 2:#1010
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666
Mailing Address - Country:US
Mailing Address - Phone:512-910-4097
Mailing Address - Fax:
Practice Address - Street 1:176 LANDA ST APT 521
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7962
Practice Address - Country:US
Practice Address - Phone:512-910-4097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional