Provider Demographics
NPI:1538975222
Name:KOEHLER, TIMOTHY (PRSS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:KOEHLER
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 CROSS LANES DR
Mailing Address - Street 2:
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143-1007
Mailing Address - Country:US
Mailing Address - Phone:304-769-8484
Mailing Address - Fax:
Practice Address - Street 1:142 CROSS LANES DR
Practice Address - Street 2:
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143-1007
Practice Address - Country:US
Practice Address - Phone:304-769-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24-9168101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty