Provider Demographics
NPI:1740646678
Name:KOENIG, KIRSTEN A (LCPC)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:A
Last Name:KOENIG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:DR
Other - First Name:KIRSTEN
Other - Middle Name:A
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:1222 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2306
Mailing Address - Country:US
Mailing Address - Phone:406-293-8766
Mailing Address - Fax:
Practice Address - Street 1:1222 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2306
Practice Address - Country:US
Practice Address - Phone:406-293-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-15792101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health