Healthcare Provider Details

I. General information

NPI: 1699329656
Provider Name (Legal Business Name): KAREN WULLAERT DEKETT MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21610 E 11 MILE RD STE 5A
SAINT CLAIR SHORES MI
48081-1671
US

IV. Provider business mailing address

21610 E 11 MILE RD STE 5A
SAINT CLAIR SHORES MI
48081-1671
US

V. Phone/Fax

Practice location:
  • Phone: 586-209-4410
  • Fax:
Mailing address:
  • Phone: 586-209-4410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401013732
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: