Provider Demographics
NPI:1447632955
Name:BAGWELL, KAREN (LPC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BAGWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 MOUNT OLIVE RD
Mailing Address - Street 2:
Mailing Address - City:ADKINS
Mailing Address - State:TX
Mailing Address - Zip Code:78101-2266
Mailing Address - Country:US
Mailing Address - Phone:210-264-2565
Mailing Address - Fax:
Practice Address - Street 1:5655 US HIGHWAY 87 E
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-1500
Practice Address - Country:US
Practice Address - Phone:210-264-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69160101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional