Provider Demographics
NPI:1174739502
Name:KLEINHEKSEL JR., JOHN ROBERT (M DIV LMSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROBERT
Last Name:KLEINHEKSEL JR.
Suffix:
Gender:M
Credentials:M DIV LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2020
Mailing Address - Country:US
Mailing Address - Phone:616-842-1985
Mailing Address - Fax:616-842-3476
Practice Address - Street 1:225 E EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-2020
Practice Address - Country:US
Practice Address - Phone:616-842-1985
Practice Address - Fax:616-842-3476
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010859151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical