Provider Demographics
NPI:1073770590
Name:SMITH, KAREN ELAINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ELAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 HAUCK DRIVE
Mailing Address - Street 2:ROLLA PSYCHOLOGICAL ASSOCIATES
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401
Mailing Address - Country:US
Mailing Address - Phone:573-364-8330
Mailing Address - Fax:573-364-8330
Practice Address - Street 1:1203 HAUCK DRIVE
Practice Address - Street 2:ROLLA PSYCHOLOGICAL ASSOCIATES
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401
Practice Address - Country:US
Practice Address - Phone:573-364-8330
Practice Address - Fax:573-364-8330
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0004111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical