Provider Demographics
NPI:1184910291
Name:CLOUSE, KRISTIN COLLEEN (MA-LMHC, LPCC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:COLLEEN
Last Name:CLOUSE
Suffix:
Gender:F
Credentials:MA-LMHC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-1623
Mailing Address - Country:US
Mailing Address - Phone:360-880-3501
Mailing Address - Fax:
Practice Address - Street 1:115 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-1623
Practice Address - Country:US
Practice Address - Phone:360-880-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60340312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health