Basic Information
| Provider Information | |||||||||
| NPI: | 1639246093 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOENIG | ||||||||
| FirstName: | ROXANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, LIMHP #442 | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KOENIG | ||||||||
| OtherFirstName: | ROXANNE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MS, LMHP #557 | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 919 GALVIN ROAD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BELLEVUE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680052207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026580103 | ||||||||
| FaxNumber: | 4022965556 | ||||||||
| Practice Location | |||||||||
| Address1: | 919 GALVIN ROAD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BELLEVUE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680052207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026580103 | ||||||||
| FaxNumber: | 4025915075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 11/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 557 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.