Provider Demographics
NPI:1831109776
Name:KOEHLER, KATHLEEN G (LCP-LMFT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:G
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:LCP-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 NACOGDOCHES RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4540
Mailing Address - Country:US
Mailing Address - Phone:210-826-9599
Mailing Address - Fax:210-826-9828
Practice Address - Street 1:3030 NACOGDOCHES RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4540
Practice Address - Country:US
Practice Address - Phone:210-826-9599
Practice Address - Fax:210-826-9828
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10193101YM0800X
TX000772-028580106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3127LCMedicare UPIN