1184910291 NPI number — KRISTIN COLLEEN CLOUSE MA-LMHC, LPCC

Table of content: KRISTIN COLLEEN CLOUSE MA-LMHC, LPCC (NPI 1184910291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184910291 NPI number — KRISTIN COLLEEN CLOUSE MA-LMHC, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLOUSE
Provider First Name:
KRISTIN
Provider Middle Name:
COLLEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA-LMHC, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184910291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 HOUSTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40361-1623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-880-3501
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 HOUSTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40361-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-880-3501
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH60340312 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com