Active NPI
Earl Jay Klebe, LCSW
- Clinical Social Worker
- Santa Ana, CA
National Provider Identifier
1972812923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 16264
- Practice address
- 2900 S. Harbor Blvd
Suite 220
Santa Ana, CA 92704 - Phone
- (562) 431-5100
- Fax
- (443) 276-0555
- NPI assigned
- Sep 24, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 Social Worker | 1041C0700X | 16264 | MD | Primary |
Addresses
Primary practice location
2900 S. Harbor Blvd
Suite 220
Santa Ana, CA 92704
Mailing address
2900 S. Harbor Blvd
Suite 220
Santa Ana, CA 92704
Phone (562) 431-5100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 15, 2020 through Jun 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16264 | MD | MD | Dentist |
| 73955 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Novus Mindful Life Institute | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483574400000",
"number": "1972812923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 S. HARBOR BLVD",
"address_2": "SUITE 220",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "92704",
"telephone_number": "562-431-5100",
"fax_number": "443-276-0555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 S. HARBOR BLVD",
"address_2": "SUITE 220",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "92704",
"telephone_number": "562-431-5100",
"fax_number": "443-276-0555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLEBE",
"first_name": "EARL",
"middle_name": "JAY",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-24",
"last_updated": "2017-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "16264",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Ana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.