Healthcare Provider Details

I. General information

NPI: 1710557327
Provider Name (Legal Business Name): KAREN OHARA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2021
Last Update Date: 06/26/2021
Certification Date: 06/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 FAIRVIEW ST
BARRE VT
05641-4719
US

IV. Provider business mailing address

210 FAIRVIEW ST
BARRE VT
05641-4719
US

V. Phone/Fax

Practice location:
  • Phone: 802-461-8817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC1931
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: