Individual
JACK BRIAN KOEHRSEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MA, LPC, LPCC
Contact information
Practice address
485 COLLIERS WAY, SUITE C, WEIRTON, WV 26062-5012
(304) 723-4260
(304) 723-4264
Mailing address
485 COLLIERS WAY, SUITE C, WEIRTON, WV 26062-5012
(304) 723-4260
(304) 723-4264
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1056
WV
101Y00000X
Counselor
E0001217
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
337925
VALUE OPTIONS
WV
01
—
AETNA
5014701
WV
01
—
ANTHEM
000000218506
OH
01
—
HEALTH PLAN
Y141250A
OH
Enumeration date
05/04/2006
Last updated
07/08/2007
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