Healthcare Provider Details

I. General information

NPI: 1649412743
Provider Name (Legal Business Name): BRIAN PAUL KLINCK PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 N 44TH ST STE 415
PHOENIX AZ
85018-7251
US

IV. Provider business mailing address

2999 N 44TH ST STE 415
PHOENIX AZ
85018-7251
US

V. Phone/Fax

Practice location:
  • Phone: 602-675-0335
  • Fax: 602-865-8089
Mailing address:
  • Phone: 602-675-0335
  • Fax: 602-865-8089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY1234
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4039
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1897
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4039
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY1234
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1897
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: