Provider Demographics
NPI:1447493804
Name:SCHADRACK, KAREN MARGARETE (MFT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MARGARETE
Last Name:SCHADRACK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:98 FAIRLANE RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5319
Mailing Address - Country:US
Mailing Address - Phone:949-496-9202
Mailing Address - Fax:949-429-1104
Practice Address - Street 1:27001 LA PAZ RD STE 254
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5524
Practice Address - Country:US
Practice Address - Phone:949-472-7505
Practice Address - Fax:949-472-0307
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38489106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist