Provider Demographics
NPI:1952051971
Name:PAGANI, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:PAGANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ISALYS
Other - Middle Name:
Other - Last Name:PAGANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1800 CLOVERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3428
Mailing Address - Country:US
Mailing Address - Phone:512-786-7224
Mailing Address - Fax:
Practice Address - Street 1:1800 CLOVERLEAF DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3428
Practice Address - Country:US
Practice Address - Phone:512-786-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87860101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123456OtherRANDOM NUMBER CHOSEN