Provider Demographics
NPI:1255466611
Name:IMALA, KAREN (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:IMALA
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 1:4211 MT VINSON WAY
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4536
Mailing Address - Country:US
Mailing Address - Phone:832-704-1577
Mailing Address - Fax:
Practice Address - Street 1:24044 CINCO VILLAGE CENTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8433
Practice Address - Country:US
Practice Address - Phone:832-356-9470
Practice Address - Fax:718-459-5621
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX510711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical