Basic Information
| Provider Information | |||||||||
| NPI: | 1558495069 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLETTER | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | ELISE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 MARKET ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941031513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155527914 | ||||||||
| FaxNumber: | 4155523455 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 MARKET ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941031513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155527914 | ||||||||
| FaxNumber: | 4155523455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 32560 | 01 | CA | BIS # | OTHER |