Provider Demographics
NPI:1114046489
Name:ELLEN P. KLEIN, MSW, PC
Entity Type:Organization
Organization Name:ELLEN P. KLEIN, MSW, PC
Other - Org Name:THE PSYCHOTHERAPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:706-369-0697
Mailing Address - Street 1:390 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1546
Mailing Address - Country:US
Mailing Address - Phone:706-369-0697
Mailing Address - Fax:706-369-0852
Practice Address - Street 1:390 SOUTHVIEW DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1546
Practice Address - Country:US
Practice Address - Phone:706-369-0697
Practice Address - Fax:706-369-0852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0007911041C0700X
GA000578106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBBCGMedicare ID - Type Unspecified