Provider Demographics
NPI:1912544776
Name:KEARBY, KAREN NICOLE (PSYD, LPC-MHSP, NCC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:NICOLE
Last Name:KEARBY
Suffix:
Gender:F
Credentials:PSYD, LPC-MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 CANTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELLABELL
Mailing Address - State:GA
Mailing Address - Zip Code:31308-5451
Mailing Address - Country:US
Mailing Address - Phone:713-851-3471
Mailing Address - Fax:
Practice Address - Street 1:87 CANTERWOOD DR
Practice Address - Street 2:
Practice Address - City:ELLABELL
Practice Address - State:GA
Practice Address - Zip Code:31308-5451
Practice Address - Country:US
Practice Address - Phone:713-851-3471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-28
Last Update Date:2019-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010870101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health