Provider Demographics
NPI:1306123302
Name:KOENIGSBERG, RACHEL M (CCHT)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:M
Last Name:KOENIGSBERG
Suffix:
Gender:F
Credentials:CCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MOUNTAIN VIEW AVE.
Mailing Address - Street 2:THE HOLISTIC WELLNESS CENTER
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501
Mailing Address - Country:US
Mailing Address - Phone:303-579-8919
Mailing Address - Fax:303-774-0116
Practice Address - Street 1:16 MOUNTAIN VIEW AVE.
Practice Address - Street 2:THE HOLISTIC WELLNESS CENTER
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3420
Practice Address - Country:US
Practice Address - Phone:303-579-8919
Practice Address - Fax:303-774-0116
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC-6856101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional