Healthcare Provider Details

I. General information

NPI: 1366604498
Provider Name (Legal Business Name): DALE ROBIN KLEIN-KENNEDY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DALE ROBIN KLEIN LPCC

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 CAMINO HERMOSA
CORRALES NM
87048-8434
US

IV. Provider business mailing address

10709 CIELO VISTA DEL NORTE
CORRALES NM
87048-8905
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-1583
  • Fax: 505-891-1768
Mailing address:
  • Phone: 505-350-4237
  • Fax: 505-843-9520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0074381
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: