Healthcare Provider Details

I. General information

NPI: 1962543058
Provider Name (Legal Business Name): KAREN SHIPLEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210A SAINT JAMES ST NORTH VILLAGE ARTS DISTRICT
COLUMBIA MO
65201-4954
US

IV. Provider business mailing address

210A SAINT JAMES ST NORTH VILLAGE ARTS DISTRICT
COLUMBIA MO
65201-4954
US

V. Phone/Fax

Practice location:
  • Phone: 603-918-9880
  • Fax:
Mailing address:
  • Phone: 603-918-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1139
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number24150
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2013007642
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: