Provider Demographics
NPI:1235533308
Name:KLEINHENZ, JOSEPH C (LCSW, CADC 1)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:C
Last Name:KLEINHENZ
Suffix:
Gender:M
Credentials:LCSW, CADC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4622 NE 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5829
Mailing Address - Country:US
Mailing Address - Phone:503-287-4796
Mailing Address - Fax:503-335-8636
Practice Address - Street 1:2318 NE MLK JR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3715
Practice Address - Country:US
Practice Address - Phone:503-802-0302
Practice Address - Fax:503-335-8636
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04-07-26101YA0400X
ORL80621041C0700X
101YM0800X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500662131Medicaid