MEDICARE: MS. KATHLEEN ELIZABETH KLINE PH.D.

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	104100000X	Social Worker	I-0000239	OH
2	103TC0700X	Clinical Psychologist	36747	TX

General Provider Information

NPI Number	:	1528151115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN ELIZABETH KLINE PH.D.

Provider Business Mailing Address
First Line	:	9100 SOUTHWEST FWY
Second Line	:	STE 100
City	:	HOUSTON
State	:	TX
Zip	:	77074-1523
Country	:	US
Telephone Number	:	832-932-0358
Fax Number	:

Provider Business Practice Location Address
First Line	:	2126 CRIMSON LAKE LN
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5339
Country	:	US
Telephone Number	:	832-932-0358
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	01/26/2016

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