Provider Demographics
NPI:1215199021
Name:BACHTELLE, KAREN MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MICHELLE
Last Name:BACHTELLE
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 1:48 S STEWART ST
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4769
Mailing Address - Country:US
Mailing Address - Phone:209-532-5424
Mailing Address - Fax:209-532-5424
Practice Address - Street 1:48 S STEWART ST
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4769
Practice Address - Country:US
Practice Address - Phone:209-532-5424
Practice Address - Fax:209-532-5424
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical