MEDICARE: MCKENZIE KOESTER LPC ASSOCIATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	83812	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83812	OTHER	TX	TEXAS STATE BOARD OF EXAMINERS COUNSELOR

General Provider Information

NPI Number	:	1508517731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENZIE KOESTER LPC ASSOCIATE

Provider Business Mailing Address
First Line	:	11467 HUEBNER RD STE 251
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1073
Country	:	US
Telephone Number	:	210-376-1314
Fax Number	:

Provider Business Practice Location Address
First Line	:	11467 HUEBNER RD STE 251
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1073
Country	:	US
Telephone Number	:	210-376-1314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	07/07/2023

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Directions to “ MCKENZIE KOESTER LPC ASSOCIATE” Practice Location

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