Provider Demographics
NPI:1073593018
Name:PLATIS, KAREN LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:PLATIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 E 3900 S
Mailing Address - Street 2:SUITE A-170
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1215
Mailing Address - Country:US
Mailing Address - Phone:801-270-6507
Mailing Address - Fax:
Practice Address - Street 1:1141 E 3900 S
Practice Address - Street 2:SUITE A-170
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1215
Practice Address - Country:US
Practice Address - Phone:801-270-6507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8312622035011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107006105101OtherIHC
UT942938348OtherCHAMPUS
UT942938348PL1OtherEDUCATORS MUTUAL
UT107006105102OtherINTRMTN HEALTH CARE
UT20022OtherDESERET MUTUAL
UTXOtherBLUE CROSS
UT20022OtherDESERET MUTUAL
UT942938348PL1OtherEDUCATORS MUTUAL