Provider Demographics
NPI:1194555243
Name:DICKS, KAREN CHARISSE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:CHARISSE
Last Name:DICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6879 MOMENTOS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-3006
Mailing Address - Country:US
Mailing Address - Phone:702-461-7676
Mailing Address - Fax:
Practice Address - Street 1:6879 MOMENTOS ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3006
Practice Address - Country:US
Practice Address - Phone:702-461-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst