Provider Demographics
NPI:1932282746
Name:BURCH, KAREN SHAW (MED, LMFT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SHAW
Last Name:BURCH
Suffix:
Gender:F
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 BRINKLEY DR
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-4211
Mailing Address - Country:US
Mailing Address - Phone:706-595-8954
Mailing Address - Fax:796-210-4842
Practice Address - Street 1:2743 PERIMETER PARKWAY
Practice Address - Street 2:SUITE 110, BUILDING 100
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909
Practice Address - Country:US
Practice Address - Phone:706-210-4843
Practice Address - Fax:706-210-4842
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist