Provider Demographics
NPI:1881708808
Name:KLEIN, CONSTANCE
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21131 BINGHAMPTON CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7300
Mailing Address - Country:US
Mailing Address - Phone:714-964-5779
Mailing Address - Fax:714-963-3359
Practice Address - Street 1:21131 BINGHAMPTON CIRCLE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7300
Practice Address - Country:US
Practice Address - Phone:714-964-5779
Practice Address - Fax:714-963-3359
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT28655106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist