Provider Demographics
NPI:1083091037
Name:FEASTER, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:FEASTER
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 1:455 GREENTREE LN NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9706
Mailing Address - Country:US
Mailing Address - Phone:616-340-2158
Mailing Address - Fax:269-686-5201
Practice Address - Street 1:455 GREENTREE LN NE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9706
Practice Address - Country:US
Practice Address - Phone:616-340-2158
Practice Address - Fax:269-686-5201
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009696101YP2500X
MI6301013038103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional