Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 39001322A | IN |
N | 101YP2500X | Professional Counselor | 39953 | IN |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 12483 | WV |
NPI | 1134379803 |
---|---|
Provider Name | Ms. Karen Rebecca Fraser-Mills |
First Address | West Lafayette, IN 47907-2050 |
Second Address | West Lafayette, IN 47907-2050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2008 |
Last Update Date | 30/09/2008 |