Provider Demographics
NPI:1336458637
Name:BALTAZAR-DURAN, KARINA K (LMFT)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:K
Last Name:BALTAZAR-DURAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9204 PIONEER FOREST DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-7943
Mailing Address - Country:US
Mailing Address - Phone:210-833-3667
Mailing Address - Fax:
Practice Address - Street 1:9204 PIONEER FOREST DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-7943
Practice Address - Country:US
Practice Address - Phone:210-833-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 62388106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA85600OtherCA LMFT LICENSE NUMBER