MEDICARE: KAREN L MIDYET PSYD PC

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	103TC0700X	Clinical Psychologist	1073	CO

General Provider Information

NPI Number	:	1619087715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN L MIDYET PSYD PC

Provider Business Mailing Address
First Line	:	2245 MERLOT CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-7048
Country	:	US
Telephone Number	:	303-944-5616
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 MERLOT CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-7048
Country	:	US
Telephone Number	:	303-944-5616
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KAREN L MIDYET
Credential	:	PSY.D.
Telephone Number	:	303-944-5616

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/06/2023

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