Provider Demographics
NPI:1578214532
Name:FLORES HERNANDEZ, KARLA MARIA
Entity Type:Individual
Prefix:
First Name:KARLA MARIA
Middle Name:
Last Name:FLORES HERNANDEZ
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 1:6322 STEEPLE CHASE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-5045
Mailing Address - Country:US
Mailing Address - Phone:516-871-7963
Mailing Address - Fax:
Practice Address - Street 1:2619 W 6TH ST STE C
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4300
Practice Address - Country:US
Practice Address - Phone:785-830-8299
Practice Address - Fax:785-749-2581
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMLP03103-T103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical