Basic Information
| Provider Information | |||||||||
| NPI: | 1710461280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLAR | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | TIMOTHY | ||||||||
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| Credential: | MA, LMHCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3806 207TH PL NE | ||||||||
| Address2: | |||||||||
| City: | SAMMAMISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980749338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252606342 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5837 221ST PL SE | ||||||||
| Address2: | |||||||||
| City: | ISSAQUAH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980278917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253910887 | ||||||||
| FaxNumber: | 4253917014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2018 | ||||||||
| LastUpdateDate: | 01/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.