Provider Demographics
NPI:1962637272
Name:KOEHNKE, ANGELA (LMFT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KOEHNKE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 OAKLAND RD
Mailing Address - Street 2:STE 403
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2866
Mailing Address - Country:US
Mailing Address - Phone:860-644-3222
Mailing Address - Fax:860-644-9730
Practice Address - Street 1:225 OAKLAND RD
Practice Address - Street 2:STE 403
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2866
Practice Address - Country:US
Practice Address - Phone:860-644-3222
Practice Address - Fax:860-644-9730
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-17
Last Update Date:2009-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000588106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist