Provider Demographics
NPI:1669775227
Name:KOENIG, MARLA M (LMFT)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:M
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 1:475 BLUEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-2005
Mailing Address - Country:US
Mailing Address - Phone:831-247-5774
Mailing Address - Fax:
Practice Address - Street 1:475 BLUEFIELD DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-2005
Practice Address - Country:US
Practice Address - Phone:831-247-5774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64837106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist