Provider Demographics
NPI:1447666383
Name:KOINONIA COUNSELING SERVICES, INC.
Entity type:Organization
Organization Name:KOINONIA COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBS, LPC
Authorized Official - Phone:580-795-6767
Mailing Address - Street 1:19990 CROWSON RD
Mailing Address - Street 2:
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446-9646
Mailing Address - Country:US
Mailing Address - Phone:580-795-6767
Mailing Address - Fax:
Practice Address - Street 1:19990 CROWSON RD
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-9646
Practice Address - Country:US
Practice Address - Phone:580-795-6767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health