Provider Demographics
NPI:1952323883
Name:VAN BUSKIRK, KARA L (MC, LPC)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:L
Last Name:VAN BUSKIRK
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:L
Other - Last Name:SHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MC, LPC
Mailing Address - Street 1:13388 W CHAPAROSA WAY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7880
Mailing Address - Country:US
Mailing Address - Phone:602-380-3919
Mailing Address - Fax:602-429-9974
Practice Address - Street 1:10640 N 28TH DR
Practice Address - Street 2:SUITE C-101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4527
Practice Address - Country:US
Practice Address - Phone:602-429-9972
Practice Address - Fax:602-429-9974
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ620302Medicaid