Provider Demographics
NPI:1336409259
Name:KOERSELMAN, AMY LYNN (LMHC, MA, NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:KOERSELMAN
Suffix:
Gender:F
Credentials:LMHC, MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 GLEN OAKS BLVD
Mailing Address - Street 2:NO. 24
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-1587
Mailing Address - Country:US
Mailing Address - Phone:712-253-2770
Mailing Address - Fax:
Practice Address - Street 1:705 DOUGLAS ST
Practice Address - Street 2:SUITE 525
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1048
Practice Address - Country:US
Practice Address - Phone:712-253-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14094101YM0800X
IA073831101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health