Provider Demographics
NPI:1629109301
Name:KOEGL, JOANNE (LMFT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:KOEGL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:245 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2717
Mailing Address - Country:US
Mailing Address - Phone:626-792-0773
Mailing Address - Fax:
Practice Address - Street 1:245 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2717
Practice Address - Country:US
Practice Address - Phone:626-792-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFCC 45854106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist