Provider Demographics
NPI:1699950857
Name:REID, KAREN MICHELLE (LMHC, BCBA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MICHELLE
Last Name:REID
Suffix:
Gender:F
Credentials:LMHC, BCBA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MICHELLE
Other - Last Name:HERINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, BCBA
Mailing Address - Street 1:21 LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1013
Mailing Address - Country:US
Mailing Address - Phone:251-605-1017
Mailing Address - Fax:
Practice Address - Street 1:21 LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1013
Practice Address - Country:US
Practice Address - Phone:251-605-1017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8946101YM0800X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health