Evan Koehn, PHD, LP
Individual provider Active NPI Clinical Psychologist · Essexville, MI
NPI 1275905911 · NPPES record last updated Aug 26, 2023
Key facts
- NPI
- 1275905911
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 6301018854 (MI)
- Practice address
- 926 W Center Rd
Essexville, MI 48732-2006 - Phone
- (989) 928-5095
- NPI assigned
- Oct 21, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Saginaw County Community Mental Health Authority
Practice addresses (Care Compare)
500 Hancock St
Saginaw, MI 48602-4224
Phone (989) 797-3400
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230331001982 | MI | Practitioner - Clinical Psychologist | 0042685208 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saginaw County Community Mental Health Authority | Current |
Accepting new patients | |
| Supportive Care I of Michigan PC | Clinical | Current |
Accepting new patients |
| Richard Kneip, PH.D., P.C. | Current |
Accepting new patients |
Locations
6548 Town Center Dr
Ste D
Clarkston, MI 48346
Phone (248) 212-8739
330 Lincoln Ave
Iron River, MI 49935
Phone (810) 445-5300
500 Hancock St
Saginaw, MI 48602
Phone (989) 797-3400
89 W South Blvd
Ste 200
Troy, MI 48085
Phone (248) 813-8840
27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301018854 | MI | Yes |
Addresses
Primary practice location
926 W Center Rd
Essexville, MI 48732-2006
Mailing address
985450 Nebraska Medical Ctr
Omaha, NE 68198-5450
Phone (402) 559-6408
Other practice location 1
444 S 44th St
Omaha, NE 68131-3727
Phone (402) 559-6408
Other providers in Essexville, MI
- Alan J Kaczynski
- Jad Aiman Kawas
- Taylor Keyes
- Abigail King
- Arturas Klugas
- Melissa Kohner
- Ekaterini Kostakos
- Olga Kostakos
- Bethany Kozielski
- Kroger Co of Michigan
All providers in Essexville, MI · Clinical Psychologist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.