Provider Demographics
NPI:1598123671
Name:KLOTZ, JAMES F (EDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:KLOTZ
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BARRETT RD
Mailing Address - Street 2:APT 1A
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-3116
Mailing Address - Country:US
Mailing Address - Phone:267-265-5250
Mailing Address - Fax:
Practice Address - Street 1:115 BARRETT RD
Practice Address - Street 2:APT 1A
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-3116
Practice Address - Country:US
Practice Address - Phone:267-265-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11624491103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool