Basic Information
| Provider Information | |||||||||
| NPI: | 1083091037 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FEASTER | ||||||||
| FirstName: | KAREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 GREENTREE LN NE | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493019706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163402158 | ||||||||
| FaxNumber: | 2696865201 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 GREENTREE LN NE | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493019706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163402158 | ||||||||
| FaxNumber: | 2696865201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2015 | ||||||||
| LastUpdateDate: | 04/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401009696 | MI | N | Behavioral Health & Social Service Providers | Counselor | Professional | 103TC1900X | 6301013038 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.