Provider Demographics
NPI:1497364566
Name:POULSEN, KARA
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:POULSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7713 HEATHERSIDE LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6978
Mailing Address - Country:US
Mailing Address - Phone:443-403-9662
Mailing Address - Fax:
Practice Address - Street 1:7713 HEATHERSIDE LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6978
Practice Address - Country:US
Practice Address - Phone:443-403-9662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician