Provider Demographics
NPI:1851795140
Name:TREECE, KARLA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:TREECE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17985 ROAD 60
Mailing Address - Street 2:
Mailing Address - City:GROVER HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45849
Mailing Address - Country:US
Mailing Address - Phone:419-587-3440
Mailing Address - Fax:
Practice Address - Street 1:17985 ROAD 60
Practice Address - Street 2:
Practice Address - City:GROVER HILL
Practice Address - State:OH
Practice Address - Zip Code:45849-9400
Practice Address - Country:US
Practice Address - Phone:419-399-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHBG1013827103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool