Provider Demographics
NPI:1659395085
Name:KLASSEN, KARIS L (MA)
Entity Type:Individual
Prefix:MS
First Name:KARIS
Middle Name:L
Last Name:KLASSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:KARIS
Other - Middle Name:L
Other - Last Name:KLASSEN-SCHROEDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:921 EAST 86TH STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1841
Mailing Address - Country:US
Mailing Address - Phone:317-259-0911
Mailing Address - Fax:
Practice Address - Street 1:921 E 86TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1859
Practice Address - Country:US
Practice Address - Phone:317-259-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000374101YM0800X
IN35001341106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000225377OtherANTHEM PIN