Provider Demographics
NPI:1144590134
Name:LEDBETTER, KAREN RENEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:RENEE
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:377 SHORT ST STE C
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-7119
Mailing Address - Country:US
Mailing Address - Phone:931-528-9399
Mailing Address - Fax:931-526-9300
Practice Address - Street 1:377 SHORT ST STE C
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-7119
Practice Address - Country:US
Practice Address - Phone:931-528-9399
Practice Address - Fax:931-526-9300
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN56251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I809768Medicare PIN