Provider Demographics
NPI:1972807477
Name:KLEIN, KAREN (MS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13121 ATLANTIC BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-0103
Mailing Address - Country:US
Mailing Address - Phone:904-614-2353
Mailing Address - Fax:
Practice Address - Street 1:10175 FORTUNE PKWY UNIT 1106
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6757
Practice Address - Country:US
Practice Address - Phone:904-614-2353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2015-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 3793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health