Provider Demographics
NPI:1659003036
Name:KRISTEN CLOW, MA, LICENSED CLINICAL PROFESSIONAL COUNSELOR, PLLC
Entity Type:Organization
Organization Name:KRISTEN CLOW, MA, LICENSED CLINICAL PROFESSIONAL COUNSELOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:217-416-0737
Mailing Address - Street 1:1221 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3548
Mailing Address - Country:US
Mailing Address - Phone:217-416-0737
Mailing Address - Fax:
Practice Address - Street 1:3233 MATHERS RD STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7900
Practice Address - Country:US
Practice Address - Phone:217-414-2064
Practice Address - Fax:217-679-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty