JACK BRIAN KOEHRSEN MA LPC LPCC NPI 1417905191

NPI Information

NPI: 1417905191
Provider Name: JACK BRIAN KOEHRSEN, MA, LPC, LPCC
Classification: Counselor - 101Y00000X
Entity Type: Individual
PECOS Registration: Yes
Address: 485 COLLIERS WAY
SUITE C
WEIRTON, WV
ZIP 26062
Phone: (304) 723-4260

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NPI Details

Jack Brian Koehrsen, MA, LPC, LPCC is a counselor in Weirton, WV. The provider is a provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification. Jack Brian Koehrsen, MA, LPC, LPCC NPI is 1417905191. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

485 COLLIERS WAY
SUITE C
WEIRTON, WV
ZIP 26062-012
Phone: (304) 723-4260
Fax: (304) 723-4264

The NPI 1417905191 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 5/4/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101Y00000X	Counselor		E0001217	OHIO	No
2	101Y00000X	Counselor		1056	WEST VIRGINIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	HEALTH PLAN	OTHER	OHIO	Y141250A
2	AETNA	OTHER	WEST VIRGINIA	5014701
3	ANTHEM	OTHER	OHIO	000000218506
4	337925	OTHER	WEST VIRGINIA	VALUE OPTIONS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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