Provider Demographics
NPI:1023194461
Name:WALLER, KAREN L (MS LPC LMHP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:WALLER
Suffix:
Gender:F
Credentials:MS LPC LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 955
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-0955
Mailing Address - Country:US
Mailing Address - Phone:308-237-5596
Mailing Address - Fax:
Practice Address - Street 1:5205 2ND AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2471
Practice Address - Country:US
Practice Address - Phone:308-237-5596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE213101YM0800X
NE262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health