Provider Demographics
NPI:1659688166
Name:DEHAVEN, KAREN A B (MA, BC-DMT, LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A B
Last Name:DEHAVEN
Suffix:
Gender:F
Credentials:MA, BC-DMT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18962-0103
Mailing Address - Country:US
Mailing Address - Phone:267-261-3779
Mailing Address - Fax:
Practice Address - Street 1:171 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-5422
Practice Address - Country:US
Practice Address - Phone:267-261-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004483101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional