Provider Demographics
NPI:1609928688
Name:KOERNER, DEBRA A (LMHC, MAC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:KOERNER
Suffix:
Gender:F
Credentials:LMHC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-0036
Mailing Address - Country:US
Mailing Address - Phone:515-230-4010
Mailing Address - Fax:
Practice Address - Street 1:803 KEELER ST.
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-0036
Practice Address - Country:US
Practice Address - Phone:515-230-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101YA0400X
IA00417101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA246085OtherMIDLANDS CHOICE, INC
IA258251OtherCOMPSYCH
IA7897570Medicaid