=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407223829
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN HARTFIELD MA, RMHCI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2015
-----------------------------------------------------
Last Update Date | 09/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 631 MIDFLORIDA DR PSYCHOLOGICAL AND NEUROBEHAVIORAL SERVICES, PA
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33813-4902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-701-9202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5968 HILLSIDE HEIGHTS DR
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33812-4322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-412-7046
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | IMH 13170
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------