MEDICARE: DR. KAREN STASHEK PHD, CLC,CMH, MH, RM

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
1	174400000X	Specialist	1111041794	NM

General Provider Information

NPI Number	:	1629315387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN STASHEK PHD, CLC,CMH, MH, RM

Provider Business Mailing Address
First Line	:	32 SUSAN K LN
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-5077
Country	:	US
Telephone Number	:	505-425-9003
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 BRIDGE ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3427
Country	:	US
Telephone Number	:	505-425-9838
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2013
Last Update Date	:	01/14/2013

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