Provider Demographics
NPI:1982385472
Name:KOEHN, HENRY CHRISTOPHER (PHD, MSCP)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:CHRISTOPHER
Last Name:KOEHN
Suffix:
Gender:M
Credentials:PHD, MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CANYON VW
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2876
Mailing Address - Country:US
Mailing Address - Phone:505-500-5812
Mailing Address - Fax:
Practice Address - Street 1:195 EAST RD STE 104
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4301
Practice Address - Country:US
Practice Address - Phone:505-412-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0923103T00000X
NMPSY-2023-0072103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty