Healthcare Provider Details

I. General information

NPI: 1326165770
Provider Name (Legal Business Name): VALERIE ANN KARN MFT INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MCHENRY VILLAGE WAY # 11
MODESTO CA
95350-4308
US

IV. Provider business mailing address

3325 SISKIYOU WAY
MODESTO CA
95350-0377
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-1440
  • Fax:
Mailing address:
  • Phone: 209-527-0967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number51313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: