Provider Demographics
NPI:1255477766
Name:BOSTICK, KAREN DENISE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DENISE
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 S HEWITT DR
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3267
Mailing Address - Country:US
Mailing Address - Phone:806-928-1453
Mailing Address - Fax:
Practice Address - Street 1:625 S HEWITT DR
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3267
Practice Address - Country:US
Practice Address - Phone:806-928-1453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182500201Medicaid