Healthcare Provider Details

I. General information

NPI: 1699287755
Provider Name (Legal Business Name): STEVE ANTON KLEIN MARRIAGE AND FAMILY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19725 SHERMAN WAY
WINNETKA CA
91306-3650
US

IV. Provider business mailing address

17040 OTSEGO ST., ENCINO, CA
ENCINO CA
91316
US

V. Phone/Fax

Practice location:
  • Phone: 310-247-8712
  • Fax:
Mailing address:
  • Phone: 818-624-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMR17904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: