Provider Demographics
NPI:1518920164
Name:KLEIN, DAVID TODD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TODD
Last Name:KLEIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 CHANDELLAY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4803
Mailing Address - Country:US
Mailing Address - Phone:314-894-6653
Mailing Address - Fax:314-845-5016
Practice Address - Street 1:1 JEFFERSON BARRACKS DR
Practice Address - Street 2:ST. LOUIS VAMC, 116B/JB
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4181
Practice Address - Country:US
Practice Address - Phone:314-894-6653
Practice Address - Fax:314-845-5016
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPYO1904103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical