=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265748099
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN L. WOLFRAM LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2010
-----------------------------------------------------
Last Update Date | 06/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 GRAND AVE, SUITE 2
-----------------------------------------------------
City | DELTA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-874-0464
-----------------------------------------------------
Fax | 970-874-0464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 96 BLUE SPRUCE DRIVE
-----------------------------------------------------
City | BAYFIELD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-250-7775
-----------------------------------------------------
Fax | 970-874-0464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 2683
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------