Provider Demographics
NPI:1679638654
Name:KOONTZ, APRIL DAWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:APRIL
Middle Name:DAWN
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:KOONTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:14500 S. OUTER 40 RD
Mailing Address - Street 2:STE #202
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-579-5040
Mailing Address - Fax:314-579-5017
Practice Address - Street 1:14500 S. OUTER 40 RD
Practice Address - Street 2:STE #202
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-579-5040
Practice Address - Fax:314-579-5017
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002018785103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent