Provider Demographics
NPI:1841423803
Name:KLEIN, ETHAN MEIR (LCSW)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:MEIR
Last Name:KLEIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 SOUTH BRAESWOOD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-3306
Mailing Address - Country:US
Mailing Address - Phone:713-667-9336
Mailing Address - Fax:713-667-3619
Practice Address - Street 1:4131 SOUTH BRAESWOOD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-3306
Practice Address - Country:US
Practice Address - Phone:713-667-9336
Practice Address - Fax:713-667-3619
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX505771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L18690Medicare PIN