Doctor Name: | DR. KELLY-LYNNE ELIZABETH KOEHLER |
NPI Number: | 1073671475 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | |
Business Practice Address: | 2050a Second St Se 377 Mdos Kirtland, NM - 871172403 |
Business Phone Number: | 5058463305 |
Business Fax Number: | |
Mailing Address: | 377 Mdos, 2050a Second St Se KIRTLAND AFB |
State: | NM |
Postal Code: | 871170001 |
Phone Number: | 5058463305 |
Fax Number: | |
NPI Enumeration Date: | 12/05/2006 |
NPI Last Update Date: | 09/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |