Provider Demographics
NPI:1619087715
Name:KAREN L MIDYET PSYD PC
Entity type:Organization
Organization Name:KAREN L MIDYET PSYD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MIDYET
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:303-944-5616
Mailing Address - Street 1:2245 MERLOT CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-7048
Mailing Address - Country:US
Mailing Address - Phone:303-944-5616
Mailing Address - Fax:
Practice Address - Street 1:2245 MERLOT CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-7048
Practice Address - Country:US
Practice Address - Phone:303-944-5616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1073103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC459638Medicare PIN