Provider Demographics
NPI:1801148101
Name:DR. JOAN L KOGELSCHATZ, PHD
Entity type:Organization
Organization Name:DR. JOAN L KOGELSCHATZ, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOGELSCHATZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:334-794-0719
Mailing Address - Street 1:921 HONEYSUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1934
Mailing Address - Country:US
Mailing Address - Phone:334-794-0719
Mailing Address - Fax:
Practice Address - Street 1:921 HONEYSUCKLE RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1934
Practice Address - Country:US
Practice Address - Phone:334-794-0719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLCSW0647C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
112273OtherUNITED BEHAVIORAL HEALTH
51041883OtherBLLUE CROSS AND BLUE SHIELD PROVIDER NUMBER
000041883OtherPTAN
4381654OtherAETNA
111860OtherCOMPSYCH CORPORATION
511/01620OtherMHCA
103651OtherTRICARE / VALUE OPTIONS PROVIDER NUMBER
17982OtherBEHAVIORAL HEALTH SYSTEMS
3001795OtherCERIDIAN
602389KOGOtherUNITED HEALTHCARE
120776000OtherMAGELLAN
1886OtherAMERICAN BEHAVIORAL
81870OtherCIGNA
ALP00397561OtherRAILROAD MEDICARE
602389KOGOtherUNITED HEALTHCARE