Provider Demographics
NPI:1700014644
Name:DECLERK, KAREN E (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:DECLERK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8444 THUNDERHEAD DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-9320
Mailing Address - Country:US
Mailing Address - Phone:303-449-4751
Mailing Address - Fax:
Practice Address - Street 1:3393 IRIS AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5205
Practice Address - Country:US
Practice Address - Phone:303-449-4751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5007101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor