Provider Demographics
NPI:1508129529
Name:KLASSEN, B GENE (MED, LPC-INTERN)
Entity Type:Individual
Prefix:MR
First Name:B
Middle Name:GENE
Last Name:KLASSEN
Suffix:
Gender:M
Credentials:MED, LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 W LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-2820
Mailing Address - Country:US
Mailing Address - Phone:214-295-5039
Mailing Address - Fax:
Practice Address - Street 1:4240 W LOVERS LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-2820
Practice Address - Country:US
Practice Address - Phone:214-295-5039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69082101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor