Provider Demographics
NPI:1538607494
Name:KARAS, KATY
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:KARAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19120 FREEPORT ST NW UNIT 457
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-5922
Mailing Address - Country:US
Mailing Address - Phone:320-345-1421
Mailing Address - Fax:320-345-1421
Practice Address - Street 1:142 WOOD DUCK LN
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-9427
Practice Address - Country:US
Practice Address - Phone:320-345-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health