Healthcare Provider Details

I. General information

NPI: 1912544776
Provider Name (Legal Business Name): KAREN NICOLE KEARBY PSYD, LPC-MHSP, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2019
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 CANTERWOOD DR
ELLABELL GA
31308-5451
US

IV. Provider business mailing address

87 CANTERWOOD DR
ELLABELL GA
31308-5451
US

V. Phone/Fax

Practice location:
  • Phone: 713-851-3471
  • Fax:
Mailing address:
  • Phone: 713-851-3471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number010870
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3633
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: