Stephanie Lyn Koontz

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1104650506 Issued in CA

Practice address

3939 Atlantic Ave Ste 102
Long Beach, CA 90807-3535

Phone

(562) 473-0830

NPI assigned

Aug 28, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1104650506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3939 ATLANTIC AVE STE 102",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908073535",
            "telephone_number": "562-473-0830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 ATLANTIC AVE STE 102",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908073535",
            "telephone_number": "562-473-0830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOONTZ",
        "first_name": "STEPHANIE",
        "middle_name": "LYN",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-28",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "1104650506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne Konigsberg, LCSW, BCD
• Anthony Konstantinidis
• Konstantinos Vlachonassios MD Inc
• Viken Razmig Konyalian, MD
• Marilyn Koo
• Ghazal Kooshk Jalali, MD
• Marcin Kopec, MD
• Rishi Ram Kora
• Rekhashree Koratagere Shivananda
• Peter L. Korchin, CO

• Addiction (Substance Use Disorder) Counselor in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.