Provider Demographics
NPI:1639246093
Name:KOENIG, ROXANNE (MS, LIMHP #442)
Entity Type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:
Last Name:KOENIG
Suffix:
Gender:F
Credentials:MS, LIMHP #442
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMHP #557
Mailing Address - Street 1:919 GALVIN ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-2207
Mailing Address - Country:US
Mailing Address - Phone:402-658-0103
Mailing Address - Fax:402-296-5556
Practice Address - Street 1:919 GALVIN ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-2207
Practice Address - Country:US
Practice Address - Phone:402-658-0103
Practice Address - Fax:402-591-5075
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health