Provider Demographics
NPI:1235744491
Name:FOLSOM, KARRIE (LEP)
Entity type:Individual
Prefix:MRS
First Name:KARRIE
Middle Name:
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DISTRICT DR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2698
Mailing Address - Country:US
Mailing Address - Phone:714-397-1006
Mailing Address - Fax:
Practice Address - Street 1:120 VANTIS DR STE 200
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2677
Practice Address - Country:US
Practice Address - Phone:714-397-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4050103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool