Provider Demographics
NPI:1487014221
Name:DAVIS, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:BLIVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC II
Mailing Address - Street 1:182 SW ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1996
Mailing Address - Country:US
Mailing Address - Phone:503-623-9289
Mailing Address - Fax:503-831-1726
Practice Address - Street 1:182 SW ACADEMY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1996
Practice Address - Country:US
Practice Address - Phone:503-623-9289
Practice Address - Fax:503-831-1726
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08-03-44101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)