Provider Demographics
NPI:1144556580
Name:STULL, KAREN MATTSON (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MATTSON
Last Name:STULL
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6929 OUTREACH WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-3493
Mailing Address - Country:US
Mailing Address - Phone:941-371-8820
Mailing Address - Fax:941-426-0324
Practice Address - Street 1:6929 OUTREACH WAY
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-3493
Practice Address - Country:US
Practice Address - Phone:941-371-8820
Practice Address - Fax:941-426-0324
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10984101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health