Healthcare Provider Details

I. General information

NPI: 1730760455
Provider Name (Legal Business Name): JASON R KLOSS PHD LMHC MCAP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2288 DREW ST. SUITE B
CLEARWATER FL
33765
US

IV. Provider business mailing address

2288 DREW ST. SUITE B
CLEARWATER FL
33765
US

V. Phone/Fax

Practice location:
  • Phone: 727-308-1330
  • Fax:
Mailing address:
  • Phone: 727-308-1330
  • 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 Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON ROBERT KLOSS
Title or Position: OWNER / SOLE MEMBER
Credential: PHD, LMHC, MCAP, LMT
Phone: 727-308-1330