Provider Demographics
NPI:1295898260
Name:BOEKE, KAREN MICHELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MICHELLE
Last Name:BOEKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 STONERIDGE RD
Mailing Address - Street 2:D 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-347-0001
Mailing Address - Fax:512-328-9803
Practice Address - Street 1:3660 STONERIDGE RD
Practice Address - Street 2:D 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-347-0001
Practice Address - Fax:512-328-9803
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4808103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical