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General NPI Number Information
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NPI Number | 1154629830
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Entity Type | Organization
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Legal Business Name | KLEINSTIVER & ASSOCIATES P.C.
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Dates
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Enumeration Date | 03/04/2011
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 6515 HIGHLAND RD STE. 110
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City | WATERFORD
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State | MI
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Zip | 48327-1668
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Country | US
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Telephone | 248-738-0301
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Fax |
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Provider Business Mailing Address
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Address Line | 6515 HIGHLAND RD STE. 110
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City | WATERFORD
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State | MI
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Zip | 48327-1668
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Country | US
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Telephone | 248-738-0301
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. RICHARD LEE KLEINSTIVER
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Credential | MSW
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Telephone | 248-738-0301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801079602
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License Number State | MI
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