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General NPI Number Information
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NPI Number | 1174013064
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Entity Type | Organization
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Legal Business Name | LISA A KOEHLER LCSW LLC
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 01/30/2021
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Provider Practice Location Address
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Address Line | 115 CAMPBELL ST STE 101
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City | GENEVA
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State | IL
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Zip | 60134-2785
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Country | US
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Telephone | 630-360-8416
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Fax |
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Provider Business Mailing Address
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Address Line | 115 CAMPBELL ST STE 101
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City | GENEVA
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State | IL
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Zip | 60134-2785
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Country | US
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Telephone | 630-360-8416
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | LISA A KOEHLER
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Credential | LLC
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Telephone | 630-360-8416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149007312
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License Number State | IL
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