MEDICARE: CARISSA KARANTH LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1255725123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA KARANTH LPC

Provider Business Mailing Address
First Line	:	1500 RUSTIC LANE
Second Line	:
City	:	WOLVERINE LAKE
State	:	MI
Zip	:	48390
Country	:	US
Telephone Number	:	248-842-3213
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 RUSTIC LANE
Second Line	:
City	:	WOLVERINE LAKE
State	:	MI
Zip	:	48390
Country	:	US
Telephone Number	:	248-842-3213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	02/21/2019

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