Provider Demographics
NPI:1184730137
Name:WASOBA, KAREN D (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:D
Last Name:WASOBA
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 S OLD HIGHWAY 94 STE 104
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5627
Mailing Address - Country:US
Mailing Address - Phone:314-299-5116
Mailing Address - Fax:636-447-3000
Practice Address - Street 1:2536 S OLD HIGHWAY 94 STE 104
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5627
Practice Address - Country:US
Practice Address - Phone:314-299-5116
Practice Address - Fax:636-447-3000
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001011582101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral