Doctor Name: | MRS. KAREN MATTSON STULL |
NPI Number: | 1144556580 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., LMHC |
License Number: | MH 10984 |
Business Practice Address: | 6929 Outreach Way North Port, FL - 342873493 |
Business Phone Number: | 9413718820 |
Business Fax Number: | 9414260324 |
Mailing Address: | 6929 Outreach Way, NORTH PORT |
State: | FL |
Postal Code: | 342873493 |
Phone Number: | 9413718820 |
Fax Number: | 9414260324 |
NPI Enumeration Date: | 10/20/2009 |
NPI Last Update Date: | 11/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH 10984 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |