Provider Demographics
NPI:1104354828
Name:GRESHAM, KAREN RENEE (LPC , NCC)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:RENEE
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:LPC , NCC
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:RENEE
Other - Last Name:VINKLAREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 CIRCLE WAY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5233
Mailing Address - Country:US
Mailing Address - Phone:979-235-0447
Mailing Address - Fax:
Practice Address - Street 1:109 CIRCLE WAY ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5233
Practice Address - Country:US
Practice Address - Phone:979-297-4335
Practice Address - Fax:979-235-0447
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC309151101YP2500X
TX70384101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty