Provider Demographics
NPI:1629469135
Name:MANSFIELD-BLAIR, KAREN (PHD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MANSFIELD-BLAIR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15655 W ROOSEVELT ST
Mailing Address - Street 2:SUITE 243
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9282
Mailing Address - Country:US
Mailing Address - Phone:623-242-7393
Mailing Address - Fax:480-659-7230
Practice Address - Street 1:15655 W ROOSEVELT ST
Practice Address - Street 2:SUITE 243
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9282
Practice Address - Country:US
Practice Address - Phone:623-242-7393
Practice Address - Fax:480-659-7230
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3950OtherSTATE OF ARIZONA