Healthcare Provider Details

I. General information

NPI: 1245633601
Provider Name (Legal Business Name): ESTHER OPAL KOEHLER MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OPAL RESPETO MS, LPC

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 07/24/2022
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N WASHINGTON ST
FARMINGTON MO
63640-1716
US

IV. Provider business mailing address

4104 LIBERTY LANDING CIR
FARMINGTON MO
63640-3636
US

V. Phone/Fax

Practice location:
  • Phone: 573-330-9374
  • Fax:
Mailing address:
  • Phone: 573-330-3974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2014034538
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2014034538
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20140034538
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: