Provider Demographics
NPI:1255112033
Name:SHANDER, KAROLINA (PHD)
Entity type:Individual
Prefix:
First Name:KAROLINA
Middle Name:
Last Name:SHANDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 FRIEDMAN LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6119
Mailing Address - Country:US
Mailing Address - Phone:630-901-9079
Mailing Address - Fax:
Practice Address - Street 1:1130 N KIMBALL AVE STE 120
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4745
Practice Address - Country:US
Practice Address - Phone:817-349-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling