Provider Demographics
NPI:1700296712
Name:KOELZER, JOSEPH HENRY JR (MA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HENRY
Last Name:KOELZER
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2687 W VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-8164
Mailing Address - Country:US
Mailing Address - Phone:425-275-8600
Mailing Address - Fax:425-320-3898
Practice Address - Street 1:2687 W VALLEY RD
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-8164
Practice Address - Country:US
Practice Address - Phone:425-275-8600
Practice Address - Fax:425-320-3898
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIN PROCESS101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)