Provider Demographics
NPI:1255349924
Name:KLEIN, DANIEL A (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:KLEIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 W MAPLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3741
Mailing Address - Country:US
Mailing Address - Phone:248-851-5437
Mailing Address - Fax:248-626-8836
Practice Address - Street 1:5665 W MAPLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3741
Practice Address - Country:US
Practice Address - Phone:248-851-5437
Practice Address - Fax:248-626-8836
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical