Provider Demographics
NPI:1649412743
Name:KLINCK, BRIAN PAUL (PSYD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PAUL
Last Name:KLINCK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 N 44TH ST STE 415
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7251
Mailing Address - Country:US
Mailing Address - Phone:602-675-0335
Mailing Address - Fax:602-865-8089
Practice Address - Street 1:2999 N 44TH ST STE 415
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7251
Practice Address - Country:US
Practice Address - Phone:602-675-0335
Practice Address - Fax:602-865-8089
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY1234103G00000X, 103TC0700X
AZ4039103TC0700X, 103G00000X
SC1897103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ441623Medicaid
AZ441623Medicaid
AZZ131154Medicare PIN