Healthcare Provider Details

I. General information

NPI: 1518920164
Provider Name (Legal Business Name): DAVID TODD KLEIN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON BARRACKS DR ST. LOUIS VAMC, 116B/JB
SAINT LOUIS MO
63125-4181
US

IV. Provider business mailing address

1454 CHANDELLAY DR
SAINT LOUIS MO
63146-4803
US

V. Phone/Fax

Practice location:
  • Phone: 314-894-6653
  • Fax: 314-845-5016
Mailing address:
  • Phone: 314-894-6653
  • Fax: 314-845-5016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPYO1904
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: