Provider Demographics
NPI:1952050460
Name:KOEN COUNSELING & WELLNESS CENTER
Entity Type:Organization
Organization Name:KOEN COUNSELING & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:KOEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:618-709-9050
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-0021
Mailing Address - Country:US
Mailing Address - Phone:618-706-9050
Mailing Address - Fax:618-706-1002
Practice Address - Street 1:223 N PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3149
Practice Address - Country:US
Practice Address - Phone:618-706-9050
Practice Address - Fax:618-706-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871832709OtherPRIVATE PAY