Provider Demographics
NPI:1417795121
Name:KOEPKE, LISA RENEA (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEA
Last Name:KOEPKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:79095-3810
Mailing Address - Country:US
Mailing Address - Phone:806-447-0147
Mailing Address - Fax:866-532-2587
Practice Address - Street 1:1510 15TH ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:TX
Practice Address - Zip Code:79095-3810
Practice Address - Country:US
Practice Address - Phone:806-447-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health