Provider Demographics
NPI:1871768903
Name:MUNDY, KLAIRE T (PSY D)
Entity type:Individual
Prefix:DR
First Name:KLAIRE
Middle Name:T
Last Name:MUNDY
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3959 ELECTRIC RD
Mailing Address - Street 2:SUITE 454
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4559
Mailing Address - Country:US
Mailing Address - Phone:540-529-9573
Mailing Address - Fax:540-269-4365
Practice Address - Street 1:3959 ELECTRIC RD
Practice Address - Street 2:SUITE 454
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4559
Practice Address - Country:US
Practice Address - Phone:540-529-9573
Practice Address - Fax:540-269-4365
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA081003938103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical