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NPI Code Detail

MEDICARE: KAREN LEE MAACK MFC

MEDICARE: KAREN LEE MAACK MFC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist425970CA

General Provider Information

NPI Number : 1083817613
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN LEE MAACK MFC
Provider Business Mailing Address
First Line : PO BOX 10452
Second Line :
City : SOUTH LAKE TAHOE
State : CA
Zip : 96158-3452
Country : US
Telephone Number : 530-545-8928
Fax Number : 530-577-4025
Provider Business Practice Location Address
First Line : 960 EMERALD BAY RD STE 5
Second Line :
City : SOUTH LAKE TAHOE
State : CA
Zip : 96150-6432
Country : US
Telephone Number : 530-545-8928
Fax Number : 530-577-4025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2007
Last Update Date : 07/08/2007

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