Basic Information
Provider Information | |||||||||
NPI: | 1710904362 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RABER | ||||||||
FirstName: | KAREN | ||||||||
MiddleName: | L. | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPCC-S | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1925 HAYES AVE | ||||||||
Address2: |   | ||||||||
City: | SANDUSKY | ||||||||
State: | OH | ||||||||
PostalCode: | 448704737 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4195575177 | ||||||||
FaxNumber: | 4195575179 | ||||||||
Practice Location | |||||||||
Address1: | 122 W CENTER ST | ||||||||
Address2: |   | ||||||||
City: | FOSTORIA | ||||||||
State: | OH | ||||||||
PostalCode: | 448302201 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4194350204 | ||||||||
FaxNumber: | 4194369846 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/17/2006 | ||||||||
LastUpdateDate: | 01/13/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | E-0004064 | OH | N |   | Behavioral Health & Social Service Providers | Counselor |   | 101YM0800X | E-004064 | OH | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
ID | Type | State | Issuer | Description | 248756000 | 01 | OH | MIS # MAGELLAN HEALTH SER | OTHER | E0004064 | 05 | OH |   | MEDICAID |