Provider Demographics
NPI:1720143167
Name:KAREN C LINDNER PHD PS
Entity Type:Organization
Organization Name:KAREN C LINDNER PHD PS
Other - Org Name:KAREN C LINDNER PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:CARR
Authorized Official - Last Name:LINDNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-674-8459
Mailing Address - Street 1:1497 SE BETHEL VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5606
Mailing Address - Country:US
Mailing Address - Phone:360-674-8459
Mailing Address - Fax:360-519-3105
Practice Address - Street 1:1730 POTTERY AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2565
Practice Address - Country:US
Practice Address - Phone:360-874-5483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAREN C LINDNER PHD PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-26
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALI0589OtherREGENCE BLUE SHIELD
WALI0589OtherREGENCE BLUE SHIELD