Provider Demographics
NPI:1629044045
Name:DIETER KAPPHAHN, KAREN L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:DIETER KAPPHAHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:L
Other - Last Name:DIETER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1164
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130
Mailing Address - Country:US
Mailing Address - Phone:530-249-6410
Mailing Address - Fax:530-252-6595
Practice Address - Street 1:130 S ROOP ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4338
Practice Address - Country:US
Practice Address - Phone:530-257-6411
Practice Address - Fax:530-257-6411
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-25
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 21751101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGB676AMedicare UPIN