Provider Demographics
NPI:1619611647
Name:KOELKER, HEATHER LAURAN (LCPC-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LAURAN
Last Name:KOELKER
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ROTHENBURG PLATZ
Mailing Address - Street 2:
Mailing Address - City:NORTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03906-6172
Mailing Address - Country:US
Mailing Address - Phone:207-752-3078
Mailing Address - Fax:
Practice Address - Street 1:2 ROTHENBURG PLATZ
Practice Address - Street 2:
Practice Address - City:NORTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03906-6172
Practice Address - Country:US
Practice Address - Phone:207-752-3078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL6536101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor