Provider Demographics
NPI:1144565060
Name:CLOUZET, TAMMY K (LPC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:K
Last Name:CLOUZET
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 W CENTRAL AVE
Mailing Address - Street 2:#106
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6334
Mailing Address - Country:US
Mailing Address - Phone:316-945-5200
Mailing Address - Fax:
Practice Address - Street 1:6700 W CENTRAL AVE
Practice Address - Street 2:#106
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-6334
Practice Address - Country:US
Practice Address - Phone:316-945-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1144565060Medicaid