Provider Demographics
NPI:1801175237
Name:CUNNINGHAM, KAREN LYNN (MFTI)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LYNN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 CORTE MALAGA
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-2030
Mailing Address - Country:US
Mailing Address - Phone:707-301-6259
Mailing Address - Fax:
Practice Address - Street 1:490 CHADBOURNE RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9613
Practice Address - Country:US
Practice Address - Phone:707-422-0465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60898101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health