Healthcare Provider Details

I. General information

NPI: 1245414465
Provider Name (Legal Business Name): KAREN LIEBOLD M.A., L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S BARTLETT RD STE 106B
STREAMWOOD IL
60107-2407
US

IV. Provider business mailing address

820 S BARTLETT RD STE 106B
STREAMWOOD IL
60107-2407
US

V. Phone/Fax

Practice location:
  • Phone: 224-318-7554
  • Fax:
Mailing address:
  • Phone: 224-318-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180004649
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: