Provider Demographics
NPI:1609756675
Name:KAARLSEN, CAMRYN
Entity type:Individual
Prefix:
First Name:CAMRYN
Middle Name:
Last Name:KAARLSEN
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 1:9448 W GRANGER CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5596
Mailing Address - Country:US
Mailing Address - Phone:208-949-8672
Mailing Address - Fax:
Practice Address - Street 1:9448 W GRANGER CT
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5596
Practice Address - Country:US
Practice Address - Phone:208-949-8672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9710101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty