Provider Demographics
NPI:1841549979
Name:KLIM, KARIE L (MFT)
Entity type:Individual
Prefix:MRS
First Name:KARIE
Middle Name:L
Last Name:KLIM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:KARIE
Other - Middle Name:LOUISE
Other - Last Name:THULON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:SAINT MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-0367
Mailing Address - Country:US
Mailing Address - Phone:707-888-0106
Mailing Address - Fax:707-539-8890
Practice Address - Street 1:170 FARMERS LANE SUITE 6B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4773
Practice Address - Country:US
Practice Address - Phone:707-888-0106
Practice Address - Fax:707-539-8890
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-8721106H00000X
CAMFC101425106H00000X
CA101425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist