Provider Demographics
NPI:1790937555
Name:BROCKMAN, KARLA (LCPC)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LIMIT ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-4435
Mailing Address - Country:US
Mailing Address - Phone:913-682-5118
Mailing Address - Fax:913-682-4664
Practice Address - Street 1:1301 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-1297
Practice Address - Country:US
Practice Address - Phone:913-367-1593
Practice Address - Fax:913-367-1627
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional