Provider Demographics
NPI:1609366699
Name:KLF COUNSELING & CONSULTING, PA
Entity Type:Organization
Organization Name:KLF COUNSELING & CONSULTING, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FORTNER
Authorized Official - Suffix:
Authorized Official - Credentials:EDS LPC CCMHC
Authorized Official - Phone:843-240-9446
Mailing Address - Street 1:PO BOX 7139
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-0007
Mailing Address - Country:US
Mailing Address - Phone:843-240-9446
Mailing Address - Fax:866-647-6536
Practice Address - Street 1:1107 48TH AVE N
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5443
Practice Address - Country:US
Practice Address - Phone:843-240-9446
Practice Address - Fax:866-647-6536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)