Provider Demographics
NPI:1275195018
Name:CLOUSE, PAULA (LCPC, LPC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:CLOUSE
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 MANNEN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2461
Mailing Address - Country:US
Mailing Address - Phone:618-204-0080
Mailing Address - Fax:
Practice Address - Street 1:301 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-3544
Practice Address - Country:US
Practice Address - Phone:618-242-4185
Practice Address - Fax:618-242-0818
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012101101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.012101OtherLICENSE