Provider Demographics
NPI:1306216742
Name:KLEIN, CHRISTOPHER JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:KLEIN
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 1:6216 S LEWIS AVE STE 138
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1084
Mailing Address - Country:US
Mailing Address - Phone:918-938-6926
Mailing Address - Fax:918-938-6971
Practice Address - Street 1:6216 S LEWIS AVE STE 138
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1084
Practice Address - Country:US
Practice Address - Phone:918-938-6926
Practice Address - Fax:918-938-6971
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1242103TS0200X, 103TS0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200612710AMedicaid