Provider Demographics
NPI:1134100233
Name:CLOUTHIER, KEVIN JOSEPH (LPC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JOSEPH
Last Name:CLOUTHIER
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 1:4139 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-3451
Mailing Address - Country:US
Mailing Address - Phone:248-288-4336
Mailing Address - Fax:248-723-6646
Practice Address - Street 1:725 S ADAMS RD
Practice Address - Street 2:L-82
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6902
Practice Address - Country:US
Practice Address - Phone:248-283-1107
Practice Address - Fax:248-723-6646
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003903101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA878123Medicare UPIN
MI2058616Medicare UPIN
MICLOUT-8956Medicare UPIN
MI233794Medicare UPIN
MI0001103253Medicare UPIN