MEDICARE: DR. JOHN P KLINE PH.D.

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
1	103TB0200X	Cognitive & Behavioral Psychologist	1399	AL
2	103TC0700X	Clinical Psychologist	1399	AL
3	103T00000X	Psychologist	1399	AL

General Provider Information

NPI Number	:	1578606174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN P KLINE PH.D.

Provider Business Mailing Address
First Line	:	30895 JOSEPH DR
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-5268
Country	:	US
Telephone Number	:	251-631-0597
Fax Number	:	251-460-4586

Provider Business Practice Location Address
First Line	:	30895 JOSEPH DR
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-5268
Country	:	US
Telephone Number	:	251-631-0597
Fax Number	:	251-460-4586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	01/10/2025

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