Healthcare Provider Details

I. General information

NPI: 1710576848
Provider Name (Legal Business Name): HARRY KLISCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 MIRAMONTE AVE STE 3
MOUNTAIN VIEW CA
94040-3718
US

IV. Provider business mailing address

2347 VINE ST
CINCINNATI OH
45219-1745
US

V. Phone/Fax

Practice location:
  • Phone: 650-930-9550
  • Fax:
Mailing address:
  • Phone: 513-621-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: