1871611491 NPI number — MR. JON SEBASTIAN KLEIN MA, LPC-S, LSOTP

Table of content: MR. JON SEBASTIAN KLEIN MA, LPC-S, LSOTP (NPI 1871611491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871611491 NPI number — MR. JON SEBASTIAN KLEIN MA, LPC-S, LSOTP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEIN
Provider First Name:
JON
Provider Middle Name:
SEBASTIAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC-S, LSOTP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871611491
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3611 S. SONCY
Provider Second Line Business Mailing Address:
SUITE 7B
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-305-1717
Provider Business Mailing Address Fax Number:
806-340-0774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3611 S. SONCY
Provider Second Line Business Practice Location Address:
SUITE 7B
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-305-1717
Provider Business Practice Location Address Fax Number:
806-340-0774
Provider Enumeration Date:
03/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  19598 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 751551522 . This is a "TAX ID#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 174634901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".