Provider Demographics
NPI:1891074027
Name:KLOCEK, CHRISTINE M
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:KLOCEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6543 GUNN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625
Mailing Address - Country:US
Mailing Address - Phone:813-374-2070
Mailing Address - Fax:813-374-0183
Practice Address - Street 1:6543 GUNN HIGHWAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625
Practice Address - Country:US
Practice Address - Phone:813-374-2070
Practice Address - Fax:813-374-0183
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst