Provider Demographics
NPI:1235562349
Name:KLYCE, DANIEL WESLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WESLEY
Last Name:KLYCE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E MARSHALL ST
Mailing Address - Street 2:P.O. BOX 980661
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-5054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 E MARSHALL ST
Practice Address - Street 2:BOX 980661
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5054
Practice Address - Country:US
Practice Address - Phone:804-628-2758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004832103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical