Provider Demographics
NPI:1952669780
Name:WEISS, KAREN R (KAREN WEISS MA TLLP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:R
Last Name:WEISS
Suffix:
Gender:F
Credentials:KAREN WEISS MA TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7191
Mailing Address - Country:US
Mailing Address - Phone:248-933-1533
Mailing Address - Fax:
Practice Address - Street 1:1290 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7191
Practice Address - Country:US
Practice Address - Phone:248-933-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014951103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical