Provider Demographics
NPI:1023574225
Name:FEHR, KLIFTON
Entity Type:Individual
Prefix:
First Name:KLIFTON
Middle Name:
Last Name:FEHR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2781 TAFT ST APT 410
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-2955
Mailing Address - Country:US
Mailing Address - Phone:754-304-9074
Mailing Address - Fax:
Practice Address - Street 1:2781 TAFT ST APT 410
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-2955
Practice Address - Country:US
Practice Address - Phone:754-304-9074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health