Provider Demographics
NPI:1679872667
Name:KLECKLEY, KARIM CAMILLE
Entity Type:Individual
Prefix:MS
First Name:KARIM
Middle Name:CAMILLE
Last Name:KLECKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KARIM
Other - Middle Name:CAMILLE
Other - Last Name:TARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:595 E CALAVERAS ST
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2265
Mailing Address - Country:US
Mailing Address - Phone:626-356-5281
Mailing Address - Fax:626-568-1914
Practice Address - Street 1:300 E WALNUT ST
Practice Address - Street 2:ROOM 200
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1580
Practice Address - Country:US
Practice Address - Phone:626-356-5281
Practice Address - Fax:626-356-9416
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional