Provider Demographics
NPI:1306993720
Name:KLIEWER, LYNN E (MFT)
Entity type:Individual
Prefix:MR
First Name:LYNN
Middle Name:E
Last Name:KLIEWER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 E DAKOTA AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4804
Mailing Address - Country:US
Mailing Address - Phone:559-453-5755
Mailing Address - Fax:559-453-4736
Practice Address - Street 1:2025 E DAKOTA AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4804
Practice Address - Country:US
Practice Address - Phone:559-453-5755
Practice Address - Fax:559-453-4736
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29593106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty