Provider Demographics
NPI:1659023505
Name:KLEIN, KATHLEEN M (LPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 PARKWAY DR S
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2619
Mailing Address - Country:US
Mailing Address - Phone:418-654-6987
Mailing Address - Fax:
Practice Address - Street 1:1070 COMMERCE DR STE 101
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5231
Practice Address - Country:US
Practice Address - Phone:419-482-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2203926101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional