MEDICARE: DR. ALAN THOMAS VON KLEISS PSYD

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	103TC0700X	Clinical Psychologist	0810004544	VA
2	103TF0200X	Forensic Psychologist	0810004544	VA
3	103TH0004X	Health Psychologist	0810004544
4	103G00000X	Clinical Neuropsychologist	0810004544	VA

General Provider Information

NPI Number	:	1790058899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN THOMAS VON KLEISS PSYD

Provider Business Mailing Address
First Line	:	1215 MALL DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4737
Country	:	US
Telephone Number	:	804-594-3690
Fax Number	:	804-794-7374

Provider Business Practice Location Address
First Line	:	1215 MALL DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4737
Country	:	US
Telephone Number	:	804-594-3690
Fax Number	:	804-794-7374

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

Provider Enumeration Date	:	02/20/2012
Last Update Date	:	07/18/2025

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