MEDICARE: SPENCER JOHN KLINE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	C.1902394	OH

General Provider Information

NPI Number	:	1114498417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER JOHN KLINE LPC

Provider Business Mailing Address
First Line	:	7393 PEARL RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-4808
Country	:	US
Telephone Number	:	440-243-4885
Fax Number	:

Provider Business Practice Location Address
First Line	:	7393 PEARL RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-4808
Country	:	US
Telephone Number	:	440-243-4885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2018
Last Update Date	:	11/04/2021

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Directions to “ SPENCER JOHN KLINE LPC” Practice Location

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