Provider Demographics
NPI:1235744491
Name:FOLSOM, KARRIE (LEP)
Entity Type:Individual
Prefix:MRS
First Name:KARRIE
Middle Name:
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7521 EDINGER AVE UNIT 4603
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-0614
Mailing Address - Country:US
Mailing Address - Phone:714-397-1006
Mailing Address - Fax:
Practice Address - Street 1:229 S DALE AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-2006
Practice Address - Country:US
Practice Address - Phone:714-527-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4050103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool