Provider Demographics
NPI:1659032068
Name:KOEHLER, THERESA KAY (PLADC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:KAY
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:KAY
Other - Last Name:SCHWOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11215 JOHN GALT BLVD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2319
Mailing Address - Country:US
Mailing Address - Phone:402-592-5900
Mailing Address - Fax:402-592-5901
Practice Address - Street 1:11215 JOHN GALT BLVD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2319
Practice Address - Country:US
Practice Address - Phone:402-592-5900
Practice Address - Fax:402-592-5901
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1629101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)