Healthcare Provider Details

I. General information

NPI: 1245653799
Provider Name (Legal Business Name): MATTHEW HENRY KLEIN LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 GUSDORF ROAD SUITE E
TAOS NM
87571
US

IV. Provider business mailing address

POST OFFICE BOX 352
ARROYO SECO NM
87514
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-4297
  • Fax: 575-751-7237
Mailing address:
  • Phone: 303-880-8699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number090626
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: