Provider Demographics
NPI:1639463441
Name:KLASSEN, RENEE RICHELLE (BABHRS)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:RICHELLE
Last Name:KLASSEN
Suffix:
Gender:F
Credentials:BABHRS
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 386
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-0386
Mailing Address - Country:US
Mailing Address - Phone:580-782-3337
Mailing Address - Fax:580-782-3338
Practice Address - Street 1:2 WICKERSHAM ST
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-9117
Practice Address - Country:US
Practice Address - Phone:580-782-3337
Practice Address - Fax:580-782-3338
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)