Healthcare Provider Details

I. General information

NPI: 1427943919
Provider Name (Legal Business Name): KAREN ANNE MEJIA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN ANNE CLARK LMFT

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 LAKE PARK WAY STE 106
LA MESA CA
91942-1674
US

IV. Provider business mailing address

772 JAMACHA RD # 234
EL CAJON CA
92019-3201
US

V. Phone/Fax

Practice location:
  • Phone: 619-807-0854
  • Fax:
Mailing address:
  • Phone: 619-807-0854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number111306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: