Provider Demographics
NPI:1669897575
Name:VAN KLEEF, PIERRETTE
Entity type:Individual
Prefix:
First Name:PIERRETTE
Middle Name:
Last Name:VAN KLEEF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PIA
Other - Middle Name:
Other - Last Name:VAN KLEEF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-0950
Mailing Address - Country:US
Mailing Address - Phone:530-529-9454
Mailing Address - Fax:530-529-9456
Practice Address - Street 1:590 ANTELOPE BLVD STE 40A
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2477
Practice Address - Country:US
Practice Address - Phone:530-529-9454
Practice Address - Fax:530-529-9456
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669897575OtherNPI