Provider Demographics
NPI:1649247883
Name:KARL E SEASHORE, LPC, PC
Entity type:Organization
Organization Name:KARL E SEASHORE, LPC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEASHORE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:801-272-0613
Mailing Address - Street 1:4190 HIGHLAND DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2600
Mailing Address - Country:US
Mailing Address - Phone:801-272-0613
Mailing Address - Fax:801-272-0678
Practice Address - Street 1:4190 HIGHLAND DR
Practice Address - Street 2:SUITE 211
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-2600
Practice Address - Country:US
Practice Address - Phone:801-272-0613
Practice Address - Fax:801-272-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT362944-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT66020OtherUNI BEHAVIORAL HEALTH NET
UT66020OtherUNI BEHAVIORAL HEALTH NET
UT=========OtherUNITED HEALTH CARE
UT=========OtherAETNA