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General NPI Number Information
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NPI Number | 1639565443
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Entity Type | Organization
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Legal Business Name | AMIE KOEHN LCSW LLC
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Dates
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Enumeration Date | 04/08/2015
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 3010 S HARVARD AVE SUITE 110
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City | TULSA
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State | OK
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Zip | 74114-6124
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Country | US
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Telephone | 918-624-9088
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Fax | 918-660-3631
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Provider Business Mailing Address
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Address Line | 3010 S HARVARD AVE SUITE 110
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City | TULSA
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State | OK
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Zip | 74114-6124
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Country | US
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Telephone | 918-624-9088
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Fax | 918-660-3631
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Authorized Official
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Title or Position | SOLE MEMBER/OWNER
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Name | AMIE MARIE KOEHN
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Credential | LCSW
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Telephone | 918-624-9088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4170
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License Number State | OK
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