Provider Demographics
NPI:1720778939
Name:MACKEY, KAREN E (PLPC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:MACKEY
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:E
Other - Last Name:ETHERIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2885 W BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3952
Mailing Address - Country:US
Mailing Address - Phone:417-761-5214
Mailing Address - Fax:
Practice Address - Street 1:4480 GRETNA RD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7202
Practice Address - Country:US
Practice Address - Phone:417-761-5492
Practice Address - Fax:417-336-1204
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023043511101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional