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General NPI Number Information
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NPI Number | 1538687371
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Entity Type | Individual
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Provider Name | MR. STEFFEN RENE KLOS
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Gender | Male
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 08/31/2017
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Provider Practice Location Address
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Address Line | 1808 HIGHWAY 190 W STE C2
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City | DERIDDER
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State | LA
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Zip | 70634-6023
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Country | US
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Telephone | 337-348-0842
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Fax |
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Provider Business Mailing Address
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Address Line | 267 COUNTY LINE RD
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City | DERIDDER
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State | LA
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Zip | 70634-6130
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Country | US
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Telephone |
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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 | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number |
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License Number State |
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