Provider Demographics
NPI:1265869812
Name:CAIN, KAREN M (LPCC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:CAIN
Suffix:
Gender:F
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:PO BOX 1154
Mailing Address - Street 2:
Mailing Address - City:PECOS
Mailing Address - State:NM
Mailing Address - Zip Code:87552-1154
Mailing Address - Country:US
Mailing Address - Phone:505-501-4933
Mailing Address - Fax:
Practice Address - Street 1:210 GUACHPANGUE RD
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3424
Practice Address - Country:US
Practice Address - Phone:505-501-4933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0152821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional