Healthcare Provider Details

I. General information

NPI: 1316402191
Provider Name (Legal Business Name): MARICELLA ELIZABETH KLINE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 GEER RD STE 120
TURLOCK CA
95382-2456
US

IV. Provider business mailing address

PO BOX 3450
TURLOCK CA
95381-3450
US

V. Phone/Fax

Practice location:
  • Phone: 209-664-8044
  • Fax:
Mailing address:
  • Phone: 209-664-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number91806
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number91806
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: