Healthcare Provider Details

I. General information

NPI: 1386614642
Provider Name (Legal Business Name): KAREN SCOTT LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 05/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 NORTH STATE ROAD 67
MOORESVILLE IN
46158
US

IV. Provider business mailing address

645 S ROGERS ST
BLOOMINGTON IN
47403-2353
US

V. Phone/Fax

Practice location:
  • Phone: 317-834-8187
  • Fax: 812-339-8109
Mailing address:
  • Phone: 812-339-1691
  • Fax: 812-339-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number39000643A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39000643A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33002574A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: