Provider Demographics
NPI:1124257316
Name:KOHLENBERGER, CAROLYN N (LPC, LMHC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:N
Last Name:KOHLENBERGER
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9156
Mailing Address - Country:US
Mailing Address - Phone:360-567-9733
Mailing Address - Fax:360-666-4990
Practice Address - Street 1:407 N PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9156
Practice Address - Country:US
Practice Address - Phone:360-567-9733
Practice Address - Fax:360-666-4990
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2014-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60034427101YM0800X
ORC2277101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional