Provider Demographics
NPI:1982691150
Name:VANDIVER, KAREN R (LPC-LMFT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:R
Last Name:VANDIVER
Suffix:
Gender:F
Credentials:LPC-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SOBRANTE
Mailing Address - Street 2:
Mailing Address - City:MORGANS POINT RESORT
Mailing Address - State:TX
Mailing Address - Zip Code:76513-8008
Mailing Address - Country:US
Mailing Address - Phone:254-780-9538
Mailing Address - Fax:254-780-9538
Practice Address - Street 1:718 S 17TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-5457
Practice Address - Country:US
Practice Address - Phone:254-780-9538
Practice Address - Fax:254-780-9538
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9000101Y00000X
TX2725106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1340LCOtherBLUECROSS BLUESHIELD