Provider Demographics
NPI:1154465698
Name:KLEIN, EILEEN MYRNA (MFT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MYRNA
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BOWDITCH
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3305
Mailing Address - Country:US
Mailing Address - Phone:714-527-2220
Mailing Address - Fax:949-733-1363
Practice Address - Street 1:5300 ORANGE AVE
Practice Address - Street 2:216
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2959
Practice Address - Country:US
Practice Address - Phone:714-527-2220
Practice Address - Fax:949-733-1363
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15294106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist