Provider Demographics
NPI:1710287073
Name:DE BOER, KARI LYN (LPC, ATR, RYT)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:LYN
Last Name:DE BOER
Suffix:
Gender:F
Credentials:LPC, ATR, RYT
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 6463
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-6463
Mailing Address - Country:US
Mailing Address - Phone:231-590-8650
Mailing Address - Fax:231-642-9101
Practice Address - Street 1:1212 VETERANS DR STE 206
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4734
Practice Address - Country:US
Practice Address - Phone:231-590-8650
Practice Address - Fax:231-642-9101
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6401011193101YP2500X
MI6401011193101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional