Healthcare Provider Details

I. General information

NPI: 1801148101
Provider Name (Legal Business Name): DR. JOAN L KOGELSCHATZ, PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 HONEYSUCKLE RD
DOTHAN AL
36305-1934
US

IV. Provider business mailing address

921 HONEYSUCKLE RD
DOTHAN AL
36305-1934
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-0719
  • Fax:
Mailing address:
  • Phone: 334-794-0719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW0647C
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier112273
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED BEHAVIORAL HEALTH
# 2
Identifier51041883
Identifier TypeOTHER
Identifier State
Identifier IssuerBLLUE CROSS AND BLUE SHIELD PROVIDER NUMBER
# 3
Identifier000041883
Identifier TypeOTHER
Identifier State
Identifier IssuerPTAN
# 4
Identifier4381654
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 5
Identifier111860
Identifier TypeOTHER
Identifier State
Identifier IssuerCOMPSYCH CORPORATION
# 6
Identifier511/01620
Identifier TypeOTHER
Identifier State
Identifier IssuerMHCA
# 7
Identifier103651
Identifier TypeOTHER
Identifier State
Identifier IssuerTRICARE / VALUE OPTIONS PROVIDER NUMBER
# 8
Identifier17982
Identifier TypeOTHER
Identifier State
Identifier IssuerBEHAVIORAL HEALTH SYSTEMS
# 9
Identifier3001795
Identifier TypeOTHER
Identifier State
Identifier IssuerCERIDIAN
# 10
Identifier602389KOG
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED HEALTHCARE
# 11
Identifier120776000
Identifier TypeOTHER
Identifier State
Identifier IssuerMAGELLAN
# 12
Identifier1886
Identifier TypeOTHER
Identifier State
Identifier IssuerAMERICAN BEHAVIORAL
# 13
Identifier81870
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 14
IdentifierP00397561
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name: DR. JOAN L KOGELSCHATZ
Title or Position: OWNER
Credential: PHD
Phone: 334-794-0719