MEDICARE: MONICA D KLISZ 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	0701004298	VA

General Provider Information

NPI Number	:	1720261761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA D KLISZ LPC

Provider Business Mailing Address
First Line	:	3111 NORTHSIDE AVE
Second Line	:	SUITE 101
City	:	RICHMOND
State	:	VA
Zip	:	23228-5441
Country	:	US
Telephone Number	:	804-366-4330
Fax Number	:	866-274-9962

Provider Business Practice Location Address
First Line	:	3111 NORTHSIDE AVE
Second Line	:	SUITE 101
City	:	RICHMOND
State	:	VA
Zip	:	23228-5441
Country	:	US
Telephone Number	:	804-366-4330
Fax Number	:	866-274-9962

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

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	02/21/2024

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