Provider Demographics
NPI:1760998389
Name:KLEIN, RAY III (LPC)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:
Last Name:KLEIN
Suffix:III
Gender:M
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:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-0057
Mailing Address - Country:US
Mailing Address - Phone:719-466-3729
Mailing Address - Fax:
Practice Address - Street 1:3225 TEMPLETON GAP RD STE 203
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8714
Practice Address - Country:US
Practice Address - Phone:719-203-7442
Practice Address - Fax:719-325-7075
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013770101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health