=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124128897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN J MASSOLL LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2006
-----------------------------------------------------
Last Update Date | 01/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2395 JOLLY RD STE 195
-----------------------------------------------------
City | OKEMOS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48864-5987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-336-4335
-----------------------------------------------------
Fax | 517-336-0101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2395 JOLLY RD STE 195
-----------------------------------------------------
City | OKEMOS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48864-5987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-336-4335
-----------------------------------------------------
Fax | 517-336-0101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 6401003482
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------