Provider Demographics
NPI:1104997246
Name:TINSLEY, KAREN LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:TINSLEY
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:PO BOX 60391
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91116
Mailing Address - Country:US
Mailing Address - Phone:310-922-0044
Mailing Address - Fax:
Practice Address - Street 1:446 S MARENGO AVE
Practice Address - Street 2:STE A
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3113
Practice Address - Country:US
Practice Address - Phone:310-922-0044
Practice Address - Fax:626-628-3277
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS197571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW19757Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER