Provider Demographics
NPI:1154767515
Name:DR KLEIN PSYCHOLOGICAL SERVICES, INC
Entity type:Organization
Organization Name:DR KLEIN PSYCHOLOGICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-244-0336
Mailing Address - Street 1:731 S HIGHWAY 101
Mailing Address - Street 2:SUITE 1-E
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2628
Mailing Address - Country:US
Mailing Address - Phone:619-244-0336
Mailing Address - Fax:
Practice Address - Street 1:731 S HIGHWAY 101
Practice Address - Street 2:SUITE 1-E
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2629
Practice Address - Country:US
Practice Address - Phone:619-244-0336
Practice Address - Fax:858-925-8035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY019804OtherNY PSYCHOLOGY LICENSE
CA25861OtherCA PSYCHOLOGY LICENSE
CT003257OtherCT PSYCHOLOGY LICENSE