Provider Demographics
NPI:1083883714
Name:GAGE, KAREN (PSYD, LMFT)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:GAGE
Suffix:
Gender:F
Credentials:PSYD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 E ELLIOT RD
Mailing Address - Street 2:SUITE 29-597
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1627
Mailing Address - Country:US
Mailing Address - Phone:480-268-7435
Mailing Address - Fax:
Practice Address - Street 1:4425 E AGAVE RD
Practice Address - Street 2:SUITE 116
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-0619
Practice Address - Country:US
Practice Address - Phone:480-268-7435
Practice Address - Fax:480-656-0011
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-10264106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11820525OtherCAQH PROVIDER ID