Provider Demographics
NPI:1568034635
Name:CLOUSE, THOMAS (LPC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:CLOUSE
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 1:7977 W WACKER RD UNIT 231
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4070
Mailing Address - Country:US
Mailing Address - Phone:480-387-8395
Mailing Address - Fax:
Practice Address - Street 1:7977 W WACKER RD UNIT 231
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4070
Practice Address - Country:US
Practice Address - Phone:480-387-8395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YP2500X
AZ19746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional