Provider Demographics
NPI:1912551318
Name:MOONSAMY, KAREN LOUANNE (BEHAVIOUR TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LOUANNE
Last Name:MOONSAMY
Suffix:
Gender:F
Credentials:BEHAVIOUR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14666 S BUCK BRUSH CIR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-3536
Mailing Address - Country:US
Mailing Address - Phone:385-368-7012
Mailing Address - Fax:
Practice Address - Street 1:515 700 E
Practice Address - Street 2:2A
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102
Practice Address - Country:US
Practice Address - Phone:800-434-8923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician