Provider Demographics
NPI:1902812753
Name:KOESTLER, PHILIP A (LPC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:A
Last Name:KOESTLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7006
Mailing Address - Country:US
Mailing Address - Phone:715-832-1678
Mailing Address - Fax:715-832-6680
Practice Address - Street 1:3119 GOLF RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7006
Practice Address - Country:US
Practice Address - Phone:715-832-1678
Practice Address - Fax:715-832-6680
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI686-125101YP2500X
WIK234000050327103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39285200Medicaid