Healthcare Provider Details

I. General information

NPI: 1093198491
Provider Name (Legal Business Name): ROBBIN L KLEIN COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 W STEPHENSON ST SUITE 209B
FREEPORT IL
61032-5057
US

IV. Provider business mailing address

524 W STEPHENSON ST SUITE 209B
FREEPORT IL
61032-5057
US

V. Phone/Fax

Practice location:
  • Phone: 815-266-1166
  • Fax:
Mailing address:
  • Phone: 815-266-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number149014030
License Number StateIL

VIII. Authorized Official

Name: ROBBIN L KLEIN
Title or Position: OWNER
Credential: LCSW
Phone: 815-266-1166