Provider Demographics
NPI:1972812923
Name:KLEBE, EARL JAY (LCSW)
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:JAY
Last Name:KLEBE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 S. HARBOR BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704
Mailing Address - Country:US
Mailing Address - Phone:562-431-5100
Mailing Address - Fax:443-276-0555
Practice Address - Street 1:2900 S. HARBOR BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704
Practice Address - Country:US
Practice Address - Phone:562-431-5100
Practice Address - Fax:443-276-0555
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD162641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical