Provider Demographics
NPI:1053718619
Name:VAN WYK, KAREN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:VAN WYK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5390 WHISPERING OAKS LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-9520
Mailing Address - Country:US
Mailing Address - Phone:817-475-1743
Mailing Address - Fax:
Practice Address - Street 1:5390 WHISPERING OAKS LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140-9520
Practice Address - Country:US
Practice Address - Phone:817-475-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX417041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical