Doctor Name: | ALICIA KLEYN |
NPI Number: | 1215396015 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | TLLP |
License Number: | 6301016409 |
Business Practice Address: | 920 Diana St Ludington, MI - 494311987 |
Business Phone Number: | 2318456294 |
Business Fax Number: | 2318457095 |
Mailing Address: | 920 Diana St, LUDINGTON |
State: | MI |
Postal Code: | 494311987 |
Phone Number: | 2318456294 |
Fax Number: | 2318457095 |
NPI Enumeration Date: | 02/22/2016 |
NPI Last Update Date: | 02/22/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | 6301016409 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |