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General NPI Number Information
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NPI Number | 1336676469
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Entity Type | Organization
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Legal Business Name | KOON COUNSELING SERVICES LMSW, P.C.
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 05/19/2017
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Provider Practice Location Address
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Address Line | 317 W 1ST ST STE 112
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City | OSWEGO
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State | NY
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Zip | 13126-3678
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Country | US
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Telephone | 315-021-6068
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Fax |
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Provider Business Mailing Address
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Address Line | 208 EASTERLY TER
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City | DE WITT
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State | NY
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Zip | 13214-2316
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER KOON
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Credential |
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Telephone | 315-430-4070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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