Provider Demographics
NPI:1922396563
Name:LINDWALL-BOURG, KAREN LYON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LYON
Last Name:LINDWALL-BOURG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 COUNTY ROAD 277
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-1705
Mailing Address - Country:US
Mailing Address - Phone:214-585-2266
Mailing Address - Fax:
Practice Address - Street 1:1216 N CENTRAL EXPY
Practice Address - Street 2:SUITE 200
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3310
Practice Address - Country:US
Practice Address - Phone:214-491-1991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61581101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional