Provider Demographics
NPI:1871118562
Name:BRUECKEN-THODEN, KAREN (RESIDENT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:BRUECKEN-THODEN
Suffix:
Gender:F
Credentials:RESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16914 CARMICHAEL PL
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-9670
Mailing Address - Country:US
Mailing Address - Phone:571-577-3667
Mailing Address - Fax:
Practice Address - Street 1:16914 CARMICHAEL PL
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-9670
Practice Address - Country:US
Practice Address - Phone:571-577-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704007717101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health