Provider Demographics
NPI:1649483363
Name:KOENIG, LAURIE LYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:LYNN
Last Name:KOENIG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:LYNN
Other - Last Name:HOLDERNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1344 REDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-5600
Mailing Address - Country:US
Mailing Address - Phone:661-428-0506
Mailing Address - Fax:866-214-3180
Practice Address - Street 1:2026 17TH ST
Practice Address - Street 2:STE 101
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4251
Practice Address - Country:US
Practice Address - Phone:661-861-1134
Practice Address - Fax:661-325-3030
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19935103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q36330Medicare UPIN
CAOPL199350Medicare ID - Type Unspecified