Provider Demographics
NPI:1154629830
Name:KLEINSTIVER & ASSOCIATES P.C.
Entity Type:Organization
Organization Name:KLEINSTIVER & ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KLEINSTIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:248-738-0301
Mailing Address - Street 1:6515 HIGHLAND RD
Mailing Address - Street 2:STE. 110
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1668
Mailing Address - Country:US
Mailing Address - Phone:248-738-0301
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801079602251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health