Provider Demographics
NPI:1134379803
Name:FRASER-MILLS, KAREN REBECCA (NCC, LMHC)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:REBECCA
Last Name:FRASER-MILLS
Suffix:
Gender:F
Credentials:NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 STADIUM MALL DR
Mailing Address - Street 2:SCHLEMAN HALL, RM 207
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907-2050
Mailing Address - Country:US
Mailing Address - Phone:765-494-1251
Mailing Address - Fax:765-496-1550
Practice Address - Street 1:475 STADIUM MALL DR
Practice Address - Street 2:SCHLEMAN HALL, RM 207
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907-2050
Practice Address - Country:US
Practice Address - Phone:765-494-1251
Practice Address - Fax:765-496-1550
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001322A101YM0800X
IN39953101YP2500X
WV12483103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral