Provider Demographics
NPI:1558890822
Name:WALL, KAREN (EDD, LMFT, RN-BC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:EDD, LMFT, RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 OSUNA RD NE APT 1018
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2291
Mailing Address - Country:US
Mailing Address - Phone:909-583-1545
Mailing Address - Fax:
Practice Address - Street 1:9500 OSUNA RD NE APT 1018
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2291
Practice Address - Country:US
Practice Address - Phone:909-583-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97283106H00000X
NMCTB-2022-0016106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558890822OtherCAQH