Basic Information
| Provider Information | |||||||||
| NPI: | 1265717599 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEINHENZ | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LPC, LCDC, RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 SAINT JAMES AVE APT 3 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452062601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133397027 | ||||||||
| FaxNumber: | 5136364283 | ||||||||
| Practice Location | |||||||||
| Address1: | 2142 ALPINE PL | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452063214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133997027 | ||||||||
| FaxNumber: | 5136364283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2011 | ||||||||
| LastUpdateDate: | 11/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 64894 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.