Provider Demographics
NPI:1083817613
Name:MAACK, KAREN LEE (MFC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:MAACK
Suffix:
Gender:F
Credentials:MFC
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 10452
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96158-3452
Mailing Address - Country:US
Mailing Address - Phone:530-545-8928
Mailing Address - Fax:530-577-4025
Practice Address - Street 1:960 EMERALD BAY RD STE 5
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6432
Practice Address - Country:US
Practice Address - Phone:530-545-8928
Practice Address - Fax:530-577-4025
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425970106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist