Healthcare Provider Details

I. General information

NPI: 1376997270
Provider Name (Legal Business Name): JOSHUA KLINK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2016
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 5TH AVE N
ST PETERSBURG FL
33713-7521
US

IV. Provider business mailing address

151 7TH ST S UNIT 205
ST PETERSBURG FL
33701-4046
US

V. Phone/Fax

Practice location:
  • Phone: 727-367-2273
  • Fax:
Mailing address:
  • Phone: 920-946-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2843-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: