Provider Demographics
NPI:1205160199
Name:KAVALOSKI, KAREN JEAN (LPCC)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:JEAN
Last Name:KAVALOSKI
Suffix:
Gender:
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E ROSEBRIER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3735
Mailing Address - Country:US
Mailing Address - Phone:417-213-1848
Mailing Address - Fax:
Practice Address - Street 1:911 E ROSEBRIER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-3735
Practice Address - Country:US
Practice Address - Phone:417-213-1848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0197151101YA0400X, 101YM0800X, 101YP2500X, 106S00000X
MO2020024537101YA0400X, 101YM0800X, 101YP2500X
MO2011041051101YM0800X
NC7492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM72980818Medicaid