Provider Demographics
NPI:1629590930
Name:KOEHLER, ELIZABETH LEIGH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEIGH
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 12TH AVE NE APT 2
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1331
Mailing Address - Country:US
Mailing Address - Phone:813-892-9518
Mailing Address - Fax:
Practice Address - Street 1:551 12TH AVE NE APT 2
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-1331
Practice Address - Country:US
Practice Address - Phone:813-892-9518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst