Doctor Name: | RYAN KLINGENSMITH |
NPI Number: | 1376897983 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | NCC, LPC |
License Number: | PC006589 |
Business Practice Address: | 4708 State Route 66 Apollo, PA - 156131404 |
Business Phone Number: | 7247273343 |
Business Fax Number: | |
Mailing Address: | 4708 State Route 66, APOLLO |
State: | PA |
Postal Code: | 156131404 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/05/2012 |
NPI Last Update Date: | 11/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC006589 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |