Provider Demographics
NPI:1568835296
Name:KLM BEHAVORIAL HEALTH
Entity Type:Organization
Organization Name:KLM BEHAVORIAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CERTIFIED ADDICTION TREATMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, CATC V
Authorized Official - Phone:626-644-8857
Mailing Address - Street 1:222 S OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4033
Mailing Address - Country:US
Mailing Address - Phone:626-584-9502
Mailing Address - Fax:
Practice Address - Street 1:222 S OAK AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4033
Practice Address - Country:US
Practice Address - Phone:626-584-9502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEDICATO TREATMENT CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA091947 V251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760753867OtherINSURANCE CARRIERS
CA1760753867Medicaid