Provider Demographics
NPI:1770631319
Name:KOEHN, LISA SUE (MSW, CSW)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:SUE
Last Name:KOEHN
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 WOODFIELD BLVD APT SUITE
Mailing Address - Street 2:
Mailing Address - City:EAST CHINA
Mailing Address - State:MI
Mailing Address - Zip Code:48054-1432
Mailing Address - Country:US
Mailing Address - Phone:810-531-5746
Mailing Address - Fax:
Practice Address - Street 1:3422 WOODFIELD BLVD APT SUITE
Practice Address - Street 2:
Practice Address - City:EAST CHINA
Practice Address - State:MI
Practice Address - Zip Code:48054-1432
Practice Address - Country:US
Practice Address - Phone:810-531-5746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801082708101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health