Provider Demographics
NPI:1619038262
Name:KLEINOT, MICHAEL (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KLEINOT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:MEADOWVIEW
Mailing Address - State:VA
Mailing Address - Zip Code:24361-0039
Mailing Address - Country:US
Mailing Address - Phone:276-783-7154
Mailing Address - Fax:
Practice Address - Street 1:29293 WALKER LANE
Practice Address - Street 2:
Practice Address - City:MEADOWVIEW
Practice Address - State:VA
Practice Address - Zip Code:24361-0039
Practice Address - Country:US
Practice Address - Phone:276-783-7154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001310103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical