Healthcare Provider Details

I. General information

NPI: 1467982785
Provider Name (Legal Business Name): KAREN WALDRIP PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: M.J. MADRID M.A.

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5203 JUAN TABO BLVD NE STE 2A
ALBUQUERQUE NM
87111-2691
US

IV. Provider business mailing address

5203 JUAN TABO BLVD NE STE 2A
ALBUQUERQUE NM
87111-2691
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-6121
  • Fax:
Mailing address:
  • Phone: 505-266-6121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0189811
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: