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General NPI Number Information
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NPI Number | 1053134643
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Entity Type | Individual
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Provider Name | BETHANY KLEINHANS LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 1301 PLANTATION ISLAND DR S STE 206A
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32080-3111
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Country | US
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Telephone | 904-420-0580
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Fax |
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Provider Business Mailing Address
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Address Line | 1513 LOW TIDE LOOP
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-2307
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Country | US
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Telephone | 507-272-3749
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW23706
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License Number State | FL
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