Healthcare Provider Details

I. General information

NPI: 1740646678
Provider Name (Legal Business Name): KIRSTEN A. KOENIG LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIRSTEN A. KOENIG LCPC

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 MINNESOTA AVE
LIBBY MT
59923-2306
US

IV. Provider business mailing address

1222 MINNESOTA AVE
LIBBY MT
59923-2306
US

V. Phone/Fax

Practice location:
  • Phone: 406-293-8766
  • Fax:
Mailing address:
  • Phone: 406-293-8766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-LCPC-LIC-15792
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: