Provider Demographics
NPI:1255340576
Name:KOENIG, SUSAN IRENE (LMFT)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:IRENE
Last Name:KOENIG
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 1:4711 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-5834
Mailing Address - Country:US
Mailing Address - Phone:916-967-4956
Mailing Address - Fax:916-965-6212
Practice Address - Street 1:4711 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-5834
Practice Address - Country:US
Practice Address - Phone:916-967-4956
Practice Address - Fax:916-965-6212
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 24989106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist