Provider Demographics
NPI:1730927948
Name:VENCE, KAREN VENCE (LMSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:VENCE
Last Name:VENCE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4197
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-5297
Mailing Address - Country:US
Mailing Address - Phone:662-545-9001
Mailing Address - Fax:
Practice Address - Street 1:906 ELM ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-4067
Practice Address - Country:US
Practice Address - Phone:662-545-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150111501106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist