Provider Demographics
NPI:1134185366
Name:WILBUR, KAREN MEAD (PHD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MEAD
Last Name:WILBUR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:W
Other - Last Name:RUEBUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4100 SPRING VALLEY RD
Mailing Address - Street 2:SUITE 511
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3629
Mailing Address - Country:US
Mailing Address - Phone:972-934-1485
Mailing Address - Fax:972-934-1498
Practice Address - Street 1:4100 SPRING VALLEY RD
Practice Address - Street 2:SUITE 511
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3629
Practice Address - Country:US
Practice Address - Phone:972-934-1485
Practice Address - Fax:972-934-1498
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34254103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
54891Medicare ID - Type Unspecified