Provider Demographics
NPI:1629300017
Name:MCCAIN, KAREN A (MA, LPC INTERN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:MA, LPC INTERN
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:COLCLASURE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPC-S
Mailing Address - Street 1:4099 MCEWEN RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5030
Mailing Address - Country:US
Mailing Address - Phone:352-226-4966
Mailing Address - Fax:972-387-3987
Practice Address - Street 1:4300 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4006
Practice Address - Country:US
Practice Address - Phone:352-374-5600
Practice Address - Fax:352-374-5608
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TX73013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor