Provider Demographics
NPI:1467460972
Name:SLAIKEU, KARL A (PHD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:A
Last Name:SLAIKEU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W 6TH ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4776
Mailing Address - Country:US
Mailing Address - Phone:512-474-5132
Mailing Address - Fax:512-474-4645
Practice Address - Street 1:1717 W 6TH ST
Practice Address - Street 2:SUITE 215
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4773
Practice Address - Country:US
Practice Address - Phone:512-474-5132
Practice Address - Fax:512-474-4645
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00FJ97OtherBC/BS OF TEXAS