Provider Demographics
NPI:1649307448
Name:HUESTIS, KAREN (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:HUESTIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:HUESTIS
Other - Last Name:ENZMINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1530 E COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1514
Mailing Address - Country:US
Mailing Address - Phone:818-244-0222
Mailing Address - Fax:818-243-5413
Practice Address - Street 1:1530 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1514
Practice Address - Country:US
Practice Address - Phone:818-244-0222
Practice Address - Fax:818-243-5413
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14154103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical