Provider Demographics
NPI:1851679872
Name:KOEHN, AMIE M (LCSW)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:M
Last Name:KOEHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 E SKELLY DR
Mailing Address - Street 2:STE 525
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6424
Mailing Address - Country:US
Mailing Address - Phone:918-640-8955
Mailing Address - Fax:918-518-7644
Practice Address - Street 1:5800 E SKELLY DR
Practice Address - Street 2:STE 525
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6424
Practice Address - Country:US
Practice Address - Phone:918-640-8955
Practice Address - Fax:918-518-7644
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41701041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical