Provider Demographics
NPI:1528028958
Name:LABOUNTY, KAREN S (PHD, LP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:LABOUNTY
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:S
Other - Last Name:BURGOYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:1462 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-5813
Mailing Address - Country:US
Mailing Address - Phone:651-232-3640
Mailing Address - Fax:651-232-3632
Practice Address - Street 1:69 EXCHANGE ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1004
Practice Address - Country:US
Practice Address - Phone:651-232-3640
Practice Address - Fax:651-232-3632
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3141103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN519552700Medicaid