Healthcare Provider Details

I. General information

NPI: 1508067562
Provider Name (Legal Business Name): THOMAS PEYTON KLINE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 WILLOW WAY
SEDONA AZ
86336-5631
US

IV. Provider business mailing address

135 WILLOW WAY
SEDONA AZ
86336-5631
US

V. Phone/Fax

Practice location:
  • Phone: 541-517-6138
  • Fax:
Mailing address:
  • Phone: 541-517-6138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC14877
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: