| Doctor Name: | JOHN KOELSCH |
| NPI Number: | 1326409913 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMSW |
| License Number: | LMSW-34382 |
| Business Practice Address: | 1675 Curlew Dr Ammon, ID - 834064850 |
| Business Phone Number: | 2085235319 |
| Business Fax Number: | 2085235627 |
| Mailing Address: | Po Box 2106, IDAHO FALLS |
| State: | ID |
| Postal Code: | 834032106 |
| Phone Number: | 2085235319 |
| Fax Number: | 2085235627 |
| NPI Enumeration Date: | 03/10/2016 |
| NPI Last Update Date: | 03/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LMSW-34382 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |