NPIMap

Organization Active NPI

Identity Development Counseling and Family Resource Center

  • Professional Counselor
  • San Antonio, TX
National Provider Identifier
1740458421
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
001123 Issued in TX
Legal business name
IDENTITY DEVELOPMENT COUNSELING AND FAMILY RESOURCE CENTER
Practice address
21714 Hardy Oak
Suite 104
San Antonio, TX 78258
Phone
(210) 490-9062
Fax
(210) 490-8843
NPI assigned
Feb 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Dr. John Henry Koiner, LPC LMFT NCC
Title
Director Owner
Phone
(210) 490-9062

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 001123 TX Primary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 000552 TX

Addresses

Primary practice location

21714 Hardy Oak
Suite 104
San Antonio, TX 78258

Mailing address

21714 Hardy Oak
Suite 104
San Antonio, TX 78258
Phone (210) 490-9062

Other identifiers 3

IdentifierTypeStateIssuer
8440LOtherBCBS
A112102OtherVALUE OPTIONS
0003OtherTRI CARE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1740458421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21714 HARDY OAK",
            "address_2": "SUITE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78258",
            "telephone_number": "210-490-9062",
            "fax_number": "210-490-8843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21714 HARDY OAK",
            "address_2": "SUITE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78258",
            "telephone_number": "210-490-9062",
            "fax_number": "210-490-8843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDENTITY DEVELOPMENT COUNSELING AND FAMILY RESOURCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-14",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "KOINER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "DIRECTOR OWNER",
        "authorized_official_telephone_number": "210-490-9062",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LPC LMFT NCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "001123",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "000552",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8440L",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "A112102",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRI CARE",
            "identifier": "0003",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.