Provider Demographics
NPI:1811045586
Name:PAGE, KAREN DIANE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:DIANE
Last Name:PAGE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MING AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-9120
Mailing Address - Country:US
Mailing Address - Phone:661-834-8341
Mailing Address - Fax:661-834-6095
Practice Address - Street 1:5500 MING AVE STE 210
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-9120
Practice Address - Country:US
Practice Address - Phone:661-834-8341
Practice Address - Fax:661-834-6095
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33975106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist