Provider Demographics
NPI:1104925940
Name:ALONSO, KAREN E (LMFT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:ALONSO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7804 E 108TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7423
Mailing Address - Country:US
Mailing Address - Phone:918-236-0273
Mailing Address - Fax:
Practice Address - Street 1:7804 E 108TH ST STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7423
Practice Address - Country:US
Practice Address - Phone:918-236-0273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1330106H00000X
CA51628106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK201040020AMedicaid