Provider Demographics
NPI:1205953528
Name:KLEES, CHARLES A (MA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:A
Last Name:KLEES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SW WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1417
Mailing Address - Country:US
Mailing Address - Phone:309-676-2400
Mailing Address - Fax:309-676-6037
Practice Address - Street 1:330 SW WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1417
Practice Address - Country:US
Practice Address - Phone:309-676-2400
Practice Address - Fax:309-676-6037
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL24131101YA0400X
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health