Provider Demographics
NPI:1790058899
Name:VON KLEISS, ALAN THOMAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:THOMAS
Last Name:VON KLEISS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 VAN HOY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6454
Mailing Address - Country:US
Mailing Address - Phone:804-241-9007
Mailing Address - Fax:
Practice Address - Street 1:1241 MALL DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4879
Practice Address - Country:US
Practice Address - Phone:804-241-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004544103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical