Basic Information
| Provider Information | |||||||||
| NPI: | 1790905909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLAHR | ||||||||
| FirstName: | JACK | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 1346 | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183429530 | ||||||||
| FaxNumber: | 9183429533 | ||||||||
| Practice Location | |||||||||
| Address1: | 17599 SOUTH HIGHWAY 88 | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183429530 | ||||||||
| FaxNumber: | 9183429533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YP2500X | 3623 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.