Basic Information
| Provider Information | |||||||||
| NPI: | 1255382305 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLUNK | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175122137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175603782 | ||||||||
| FaxNumber: | 7175603787 | ||||||||
| Practice Location | |||||||||
| Address1: | 306 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175122137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175603782 | ||||||||
| FaxNumber: | 7175603787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2006 | ||||||||
| LastUpdateDate: | 04/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS004321L | PA | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 188819 | 01 | PA | VALUE OPTIONS | OTHER | 50000097 | 01 | PA | CAPITAL BLUE CROSS | OTHER |