Provider Demographics
NPI:1235764994
Name:KLINK, LIGI LUKE (MSAC)
Entity Type:Individual
Prefix:
First Name:LIGI
Middle Name:LUKE
Last Name:KLINK
Suffix:
Gender:F
Credentials:MSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 W MARQUITA APT A
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-6736
Mailing Address - Country:US
Mailing Address - Phone:949-391-5290
Mailing Address - Fax:
Practice Address - Street 1:164 W MARQUITA APT A
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-6736
Practice Address - Country:US
Practice Address - Phone:949-391-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)