Provider Demographics
NPI:1811907553
Name:KOEWLER, JOHN H (PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:KOEWLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S SCHWARTZ AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5955
Mailing Address - Country:US
Mailing Address - Phone:505-327-4998
Mailing Address - Fax:
Practice Address - Street 1:555 S SCHWARTZ AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5955
Practice Address - Country:US
Practice Address - Phone:505-327-4998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist