Provider Demographics
NPI:1093932808
Name:BRUCE E. KLINE PSYD & ASSOCIATES
Entity Type:Organization
Organization Name:BRUCE E. KLINE PSYD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KANIUGA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPCC
Authorized Official - Phone:937-426-2686
Mailing Address - Street 1:1411 N FAIRFIELD RD STE B
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2683
Mailing Address - Country:US
Mailing Address - Phone:937-426-2686
Mailing Address - Fax:937-429-3423
Practice Address - Street 1:1411 N FAIRFIELD RD STE B
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2683
Practice Address - Country:US
Practice Address - Phone:937-426-2686
Practice Address - Fax:937-429-3423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty