Provider Demographics
NPI:1245968593
Name:KLONIS, SPERO (LCDC)
Entity type:Individual
Prefix:
First Name:SPERO
Middle Name:
Last Name:KLONIS
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14602 PRESIDIO SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1654
Mailing Address - Country:US
Mailing Address - Phone:281-895-3270
Mailing Address - Fax:
Practice Address - Street 1:14602 PRESIDIO SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-1654
Practice Address - Country:US
Practice Address - Phone:281-895-3270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11432101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000000000Medicaid
TX1811641095Medicaid