Provider Demographics
NPI:1699329656
Name:DEKETT, KAREN WULLAERT (MA, LPC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:WULLAERT
Last Name:DEKETT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E FERRY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3802
Mailing Address - Country:US
Mailing Address - Phone:734-785-7705
Mailing Address - Fax:
Practice Address - Street 1:40 E FERRY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3802
Practice Address - Country:US
Practice Address - Phone:734-785-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013732101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor