Provider Demographics
NPI:1982791620
Name:HIGGINBOTHAM, KAREN LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LEE
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 E MISSISSIPPI AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3048
Mailing Address - Country:US
Mailing Address - Phone:303-380-0114
Mailing Address - Fax:303-759-3515
Practice Address - Street 1:4100 E MISSISSIPPI AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-3048
Practice Address - Country:US
Practice Address - Phone:303-380-0114
Practice Address - Fax:303-759-3515
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1183103TA0700X, 103TC0700X, 103TC2200X, 103TP2701X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07011839Medicaid
CO87556Medicare ID - Type Unspecified
CO07011839Medicaid