Provider Demographics
NPI:1518397678
Name:KLINK, JOHN (CMII)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KLINK
Suffix:
Gender:M
Credentials:CMII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 COUNTRY AIRE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-7728
Mailing Address - Country:US
Mailing Address - Phone:918-424-2627
Mailing Address - Fax:918-426-4820
Practice Address - Street 1:118 COUNTRY AIRE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7728
Practice Address - Country:US
Practice Address - Phone:918-424-2627
Practice Address - Fax:918-426-4820
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health