Healthcare Provider Details

I. General information

NPI: 1831599885
Provider Name (Legal Business Name): JENNY V KARSTAD LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ANNA MARSH LANE
BRATTLEBORO VT
05302-0101
US

IV. Provider business mailing address

PO BOX 101
BRATTLEBORO VT
05302-0101
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-7785
  • Fax: 802-258-3723
Mailing address:
  • Phone: 802-257-7785
  • Fax: 802-258-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0057641
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: