Provider Demographics
NPI:1477823102
Name:CLUTE, KRISTEN
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:CLUTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SANTA ROSA CT
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-4423
Mailing Address - Country:US
Mailing Address - Phone:949-562-5166
Mailing Address - Fax:
Practice Address - Street 1:122 SANTA ROSA CT
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-4423
Practice Address - Country:US
Practice Address - Phone:949-562-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC3669101YP2500X
CALMFT 97187106H00000X
101YP2500X, 106H00000X, 106H00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist