Provider Demographics
NPI:1053434738
Name:KLEINSASSER, LEWIS DENNIS (PHD)
Entity type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:DENNIS
Last Name:KLEINSASSER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 SOUTHGATE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-2605
Mailing Address - Country:US
Mailing Address - Phone:719-633-7100
Mailing Address - Fax:719-633-7170
Practice Address - Street 1:2135 SOUTHGATE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-2605
Practice Address - Country:US
Practice Address - Phone:719-633-7100
Practice Address - Fax:719-633-7170
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO752103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical