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NPI Code Detail

MEDICARE: DR. HARRY FITCH KLINEFELTER III PHD

MEDICARE:  DR. HARRY FITCH KLINEFELTER III PHD
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
1103T00000XPsychologist22655TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100F14COTHERTXBC BS TX
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700887528
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HARRY FITCH KLINEFELTER III PHD
Provider Business Mailing Address
First Line : 3509 HULEN ST
Second Line : BLDG 2 STE 250
City : FORT WORTH
State : TX
Zip : 76107-6862
Country : US
Telephone Number : 817-735-8245
Fax Number : 817-735-4966
Provider Business Practice Location Address
First Line : 3509 HULEN ST
Second Line : BLDG 2 STE 250
City : FORT WORTH
State : TX
Zip : 76107-6862
Country : US
Telephone Number : 817-735-8245
Fax Number : 817-735-4966
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 06/19/2008

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