Provider Demographics
NPI:1003053166
Name:KARASZ-ROTHELL, JAN (LMFT)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:KARASZ-ROTHELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EL CERRO RD
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7131
Mailing Address - Country:US
Mailing Address - Phone:505-385-4242
Mailing Address - Fax:505-866-1186
Practice Address - Street 1:20 EL CERRO RD
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-7131
Practice Address - Country:US
Practice Address - Phone:505-385-4242
Practice Address - Fax:505-866-1186
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0082711106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist