Provider Demographics
NPI:1104183706
Name:KAREN D RASILE PHD PLLC
Entity Type:Organization
Organization Name:KAREN D RASILE PHD PLLC
Other - Org Name:KAREN D RASILE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RASILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-530-8616
Mailing Address - Street 1:PO BOX 2346
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77834-2346
Mailing Address - Country:US
Mailing Address - Phone:979-530-8616
Mailing Address - Fax:979-421-6039
Practice Address - Street 1:105 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-3849
Practice Address - Country:US
Practice Address - Phone:979-530-8616
Practice Address - Fax:979-421-6039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24055103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131122707Medicaid
TX87277AOtherBCBS
TXP000K98HZMedicaid
TX00K98HMedicare PIN
TX131122707Medicaid