Provider Demographics
NPI:1144669201
Name:STARK, KAREN MARIE (LPC INTERN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:STARK
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DOWNS LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1900
Mailing Address - Country:US
Mailing Address - Phone:469-374-7661
Mailing Address - Fax:
Practice Address - Street 1:5402 ARAPAHO RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-6905
Practice Address - Country:US
Practice Address - Phone:972-437-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional