Healthcare Provider Details

I. General information

NPI: 1982630265
Provider Name (Legal Business Name): KAREN E COURCHAINE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S MARION AVE NORTH FLORIDA/SOUTH GEORGIA VETERANS HEALTH SYSTEM
LAKE CITY FL
32025-5808
US

IV. Provider business mailing address

619 S MARION AVE NORTH FLORIDA/SOUTH GEORGIA VETERANS HEALTH SYSTEM
LAKE CITY FL
32025-5808
US

V. Phone/Fax

Practice location:
  • Phone: 386-755-3016
  • Fax: 386-754-7370
Mailing address:
  • Phone: 386-755-3016
  • Fax: 386-754-7370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY5513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: