Provider Demographics
NPI:1033438395
Name:KLEINSTIVER, RICHARD LEE (LMSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEE
Last Name:KLEINSTIVER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 ESTES CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1730
Mailing Address - Country:US
Mailing Address - Phone:248-931-9989
Mailing Address - Fax:
Practice Address - Street 1:6515 HIGHLAND RD
Practice Address - Street 2:STE. 110
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1668
Practice Address - Country:US
Practice Address - Phone:248-738-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010796021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical