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General NPI Number Information
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NPI Number | 1780102327
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Entity Type | Individual
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Provider Name | JONATHAN ROBERT KLOK MA, LLPC, TLLP
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Gender | Male
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Dates
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Enumeration Date | 09/04/2017
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Last Update Date | 09/04/2017
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Provider Practice Location Address
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Address Line | 6963 WEST KL AVE. SUITE A
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City | KALAMAZOO
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State | MI
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Zip | 49009
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Country | US
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Telephone | 269-459-9790
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Fax |
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Provider Business Mailing Address
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Address Line | 813 W. LOVELL ST. APT. 304B
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City | KALAMAZOO
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State | MI
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Zip | 49007
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Country | US
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Telephone | 269-358-8913
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401015600
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License Number State | MI
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