Provider Demographics
NPI:1629315387
Name:STASHEK, KAREN (PHD, CLC,CMH, MH, RM)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:STASHEK
Suffix:
Gender:F
Credentials:PHD, CLC,CMH, MH, RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SUSAN K LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-5077
Mailing Address - Country:US
Mailing Address - Phone:505-425-9003
Mailing Address - Fax:
Practice Address - Street 1:128 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3427
Practice Address - Country:US
Practice Address - Phone:505-425-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1111041794174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist