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Organization
IDENTITY DEVELOPMENT COUNSELING AND FAMILY RESOURCE CENTER
Active
Organization
IDENTITY DEVELOPMENT COUNSELING AND FAMILY RESOURCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN HENRY KOINER LPC LMFT NCC (DIRECTOR OWNER)
(210) 490-9062
Entity
Organization
Contact information
Practice address
21714 HARDY OAK, SUITE 104, SAN ANTONIO, TX 78258
(210) 490-9062
(210) 490-8843
Mailing address
21714 HARDY OAK, SUITE 104, SAN ANTONIO, TX 78258
(210) 490-9062
(210) 490-8843
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
001123
TX
106H00000X
Marriage & Family Therapist
000552
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003
TRI CARE
—
01
—
8440L
BCBS
—
01
—
A112102
VALUE OPTIONS
—
Enumeration date
02/14/2008
Last updated
04/20/2008
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