Provider Demographics
NPI:1578668521
Name:WATKINS, KAREN THERESA (LCPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:THERESA
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 WOODGLEN LN
Mailing Address - Street 2:#108
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-4550
Mailing Address - Country:US
Mailing Address - Phone:630-740-5351
Mailing Address - Fax:630-985-6527
Practice Address - Street 1:346 TAFT AVE
Practice Address - Street 2:SUITE 030
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6296
Practice Address - Country:US
Practice Address - Phone:630-740-5351
Practice Address - Fax:630-985-6527
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-000944101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180-000944OtherSTATE LICENSE
IL300336310OtherEIN TAX IDENTIFIER