Provider Demographics
NPI:1669561502
Name:KOERNER, JUDITH A (LMFT)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:A
Last Name:KOERNER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:KOERNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:876 N MOUNTAIN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4166
Mailing Address - Country:US
Mailing Address - Phone:909-931-3388
Mailing Address - Fax:909-931-7311
Practice Address - Street 1:876 N MOUNTAIN AVE
Practice Address - Street 2:STE 200
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4166
Practice Address - Country:US
Practice Address - Phone:909-931-3388
Practice Address - Fax:909-931-7311
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 16949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist