Provider Demographics
NPI:1003314360
Name:WILFONG, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WILFONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12406 SCHERER WOODS CT
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-1600
Mailing Address - Country:US
Mailing Address - Phone:281-615-0122
Mailing Address - Fax:
Practice Address - Street 1:10609 GRANT RD BLDG B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4462
Practice Address - Country:US
Practice Address - Phone:281-469-6395
Practice Address - Fax:281-970-0414
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty