Provider Demographics
NPI:1508517731
Name:KOESTER, MCKENZIE (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:KOESTER
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11467 HUEBNER RD STE 251
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1073
Mailing Address - Country:US
Mailing Address - Phone:210-376-1314
Mailing Address - Fax:
Practice Address - Street 1:11467 HUEBNER RD STE 251
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1073
Practice Address - Country:US
Practice Address - Phone:210-376-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83812101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83812OtherTEXAS STATE BOARD OF EXAMINERS COUNSELOR