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NPI Code Detail

MEDICARE: LYNN M KLEIST LCSW

MEDICARE: LYNN M KLEIST LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker18691CA

General Provider Information

NPI Number : 1013016856
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN M KLEIST LCSW
Provider Business Mailing Address
First Line : 3631 S HARBOR BLVD STE 200
Second Line :
City : SANTA ANA
State : CA
Zip : 92704-7936
Country : US
Telephone Number : 657-356-6687
Fax Number : 657-356-6290
Provider Business Practice Location Address
First Line : 3631 S HARBOR BLVD STE 200
Second Line :
City : SANTA ANA
State : CA
Zip : 92704-7936
Country : US
Telephone Number : 657-356-6687
Fax Number : 657-356-6290
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 02/07/2024

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