Provider Demographics
NPI:1215589957
Name:KLAIN, STEPHAN
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:
Last Name:KLAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:KAIBETO
Mailing Address - State:AZ
Mailing Address - Zip Code:86053-2147
Mailing Address - Country:US
Mailing Address - Phone:928-673-3267
Mailing Address - Fax:928-673-3269
Practice Address - Street 1:1/2 MILE SOUTH OF KAIBETO MARKET BLDG #7986A
Practice Address - Street 2:
Practice Address - City:KAIBETO
Practice Address - State:AZ
Practice Address - Zip Code:86053
Practice Address - Country:US
Practice Address - Phone:928-673-3267
Practice Address - Fax:928-673-3269
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2019-133101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty