Provider Demographics
NPI:1053808584
Name:KLEMM, DAVID JOSEPH (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:KLEMM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 E MAIN ST STE 40
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2398
Mailing Address - Country:US
Mailing Address - Phone:630-513-6277
Mailing Address - Fax:630-513-4277
Practice Address - Street 1:1750 E MAIN ST STE 40
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2398
Practice Address - Country:US
Practice Address - Phone:630-513-6277
Practice Address - Fax:630-513-4277
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional