Provider Demographics
NPI:1336203785
Name:NORDEEN, KAREN E (LMFT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:NORDEEN
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:PO BOX 3342
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95402-3342
Mailing Address - Country:US
Mailing Address - Phone:707-583-2323
Mailing Address - Fax:
Practice Address - Street 1:2227 CAPRICORN WAY STE 211
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5486
Practice Address - Country:US
Practice Address - Phone:707-565-5691
Practice Address - Fax:707-565-5694
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36611106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336203785Medicaid
CA106H00000XOtherCALIFORNIA