Provider Demographics
NPI:1689396350
Name:KOENINGER, MARTHA JEAN (LAC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JEAN
Last Name:KOENINGER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 LINWOOD DR STE G
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5365
Mailing Address - Country:US
Mailing Address - Phone:870-604-4455
Mailing Address - Fax:870-572-2892
Practice Address - Street 1:9101 N RODNEY PARHAM RD STE B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1685
Practice Address - Country:US
Practice Address - Phone:501-389-8100
Practice Address - Fax:870-572-2891
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2010146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health