Provider Demographics
NPI:1376917625
Name:MALSOM, KAREN (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MALSOM
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMHC
Mailing Address - Street 1:4350 CORDATA PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8278
Mailing Address - Country:US
Mailing Address - Phone:360-922-6977
Mailing Address - Fax:
Practice Address - Street 1:4350 CORDATA PKWY STE 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8278
Practice Address - Country:US
Practice Address - Phone:360-922-6977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60619103101Y00000X, 101YM0800X
103K00000X
WALH61220774101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst