Active NPI
Bethany Klim
- Clinical Psychologist
- Sacramento, CA
National Provider Identifier
1770754277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1631
- Practice address
- 4330 Auburn Blvd
Ste 2200
Sacramento, CA 95841-4167 - Phone
- (916) 473-5764
- NPI assigned
- Mar 12, 2008
- Last updated
- Jan 7, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1631 | AL | Primary |
Addresses
Primary practice location
4330 Auburn Blvd
Ste 2200
Sacramento, CA 95841-4167
Mailing address
1554 Oneida St
Appleton, WI 54915-7025
Phone (920) 636-0278
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14176331 | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1631 | AL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515283200000",
"number": "1770754277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1554 ONEIDA ST",
"city": "APPLETON",
"state": "WI",
"postal_code": "549157025",
"telephone_number": "920-636-0278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4330 AUBURN BLVD",
"address_2": "STE 2200",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958414167",
"telephone_number": "916-473-5764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLIM",
"first_name": "BETHANY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-12",
"last_updated": "2018-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AL",
"license": "1631",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "14176331",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.