Provider Demographics
NPI:1871611491
Name:KLEIN, JON SEBASTIAN (MA, LPC-S, LSOTP)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:SEBASTIAN
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MA, LPC-S, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 S. SONCY
Mailing Address - Street 2:SUITE 7B
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119
Mailing Address - Country:US
Mailing Address - Phone:806-305-1717
Mailing Address - Fax:806-340-0774
Practice Address - Street 1:3611 S. SONCY
Practice Address - Street 2:SUITE 7B
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119
Practice Address - Country:US
Practice Address - Phone:806-305-1717
Practice Address - Fax:806-340-0774
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX751551522OtherTAX ID#
TX174634901Medicaid