Healthcare Provider Details

I. General information

NPI: 1720852429
Provider Name (Legal Business Name): KLINGENSMITH COUNSELING AND PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 JADWIN AVE UNIT 719-11
RICHLAND WA
99352-4217
US

IV. Provider business mailing address

719 JADWIN AVE UNIT 719-11
RICHLAND WA
99352-4217
US

V. Phone/Fax

Practice location:
  • Phone: 509-214-1894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELA KLINGENSMITH
Title or Position: PSYCHOLOGIST/OWNER
Credential: PSYD
Phone: 509-214-1894