Provider Demographics
NPI:1467982785
Name:WALDRIP, KAREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:WALDRIP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:M.J.
Other - Middle Name:
Other - Last Name:MADRID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:5203 JUAN TABO BLVD NE STE 2A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2691
Mailing Address - Country:US
Mailing Address - Phone:505-266-6121
Mailing Address - Fax:
Practice Address - Street 1:5203 JUAN TABO BLVD NE STE 2A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2691
Practice Address - Country:US
Practice Address - Phone:505-266-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0189811101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health