Provider Demographics
NPI:1275093080
Name:KLEIN, TERRY DEWAYNE (LMFT)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:DEWAYNE
Last Name:KLEIN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 POWELL PT APT 105
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-2841
Mailing Address - Country:US
Mailing Address - Phone:719-232-2075
Mailing Address - Fax:
Practice Address - Street 1:7750 N UNION BLVD STE 208
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4051
Practice Address - Country:US
Practice Address - Phone:714-599-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT370101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health