Doctor Name: | MR. PHILLIP EDWARD VAN KLEECK |
NPI Number: | 1093990061 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA |
License Number: | MH 9545 |
Business Practice Address: | 2523 Us Highway 27 S Suite 130 Avon Park, FL - 338259690 |
Business Phone Number: | 8639915209 |
Business Fax Number: | |
Mailing Address: | 2523 Us Highway 27 S, Suite 130 AVON PARK |
State: | FL |
Postal Code: | 338259690 |
Phone Number: | 8639915209 |
Fax Number: | |
NPI Enumeration Date: | 01/08/2008 |
NPI Last Update Date: | 08/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH 9545 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |