MEDICARE: KAREN KLEIN M.S.

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	101YM0800X	Mental Health Counselor	MH 3793	FL

General Provider Information

NPI Number	:	1972807477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN KLEIN M.S.

Provider Business Mailing Address
First Line	:	13121 ATLANTIC BLVD
Second Line	:	SUITE 100
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-0103
Country	:	US
Telephone Number	:	904-614-2353
Fax Number	:

Provider Business Practice Location Address
First Line	:	10175 FORTUNE PKWY UNIT 1106
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6757
Country	:	US
Telephone Number	:	904-614-2353
Fax Number	:

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

Provider Enumeration Date	:	12/27/2010
Last Update Date	:	03/28/2015

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