Provider Demographics
NPI:1013151398
Name:ROUFF, KAREN TYNER (LMSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:TYNER
Last Name:ROUFF
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S WEST ST
Mailing Address - Street 2:#150
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2521
Mailing Address - Country:US
Mailing Address - Phone:248-988-7465
Mailing Address - Fax:248-644-2415
Practice Address - Street 1:415 S WEST ST
Practice Address - Street 2:#150
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2521
Practice Address - Country:US
Practice Address - Phone:248-988-7465
Practice Address - Fax:248-644-2415
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010338591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION15350Medicare PIN