Provider Demographics
NPI:1982839098
Name:DR. THEODORA H. KOEHN, P.C.
Entity Type:Organization
Organization Name:DR. THEODORA H. KOEHN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORA
Authorized Official - Middle Name:HART
Authorized Official - Last Name:KOEHN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:214-435-4620
Mailing Address - Street 1:17300 PRESTON RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5654
Mailing Address - Country:US
Mailing Address - Phone:214-435-4620
Mailing Address - Fax:972-733-6564
Practice Address - Street 1:17300 PRESTON RD
Practice Address - Street 2:SUITE 160
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5654
Practice Address - Country:US
Practice Address - Phone:214-435-4620
Practice Address - Fax:972-733-6564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty