Provider Demographics
NPI:1942503404
Name:KARIS PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:KARIS PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYLOU
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-561-2397
Mailing Address - Street 1:708 FLORSHEIM DR STE 13
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5001
Mailing Address - Country:US
Mailing Address - Phone:847-561-2397
Mailing Address - Fax:
Practice Address - Street 1:708 FLORSHEIM DR
Practice Address - Street 2:#13
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5001
Practice Address - Country:US
Practice Address - Phone:847-561-2397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty