Provider Demographics
NPI:1255388435
Name:AMBRUM, KAREN L (LMFT)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:L
Last Name:AMBRUM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3385 MARINERS WAY
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-9438
Mailing Address - Country:US
Mailing Address - Phone:772-388-1933
Mailing Address - Fax:772-388-1933
Practice Address - Street 1:1365 18TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3577
Practice Address - Country:US
Practice Address - Phone:772-538-0690
Practice Address - Fax:772-388-1933
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2018106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist