Provider Demographics
NPI:1477937316
Name:HENDREN, KAREN (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HENDREN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 504
Mailing Address - Street 2:
Mailing Address - City:KOOSKIA
Mailing Address - State:ID
Mailing Address - Zip Code:83539-0504
Mailing Address - Country:US
Mailing Address - Phone:208-413-1200
Mailing Address - Fax:208-935-7652
Practice Address - Street 1:611 4TH STREET
Practice Address - Street 2:
Practice Address - City:KAMIAH
Practice Address - State:ID
Practice Address - Zip Code:83536-1769
Practice Address - Country:US
Practice Address - Phone:208-413-1200
Practice Address - Fax:208-983-7652
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
ID34971101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)