Provider Demographics
NPI:1700114477
Name:KOEHLER, JUDITH ANN (MA, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:MRS
Other - First Name:JUDY
Other - Middle Name:ANN
Other - Last Name:KOEHLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC, NCC
Mailing Address - Street 1:225 S MERAMEC AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3511
Mailing Address - Country:US
Mailing Address - Phone:314-249-5444
Mailing Address - Fax:314-863-5904
Practice Address - Street 1:225 S MERAMEC AVE STE 404
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3511
Practice Address - Country:US
Practice Address - Phone:314-249-5444
Practice Address - Fax:314-863-5904
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007031021101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor