Provider Demographics
NPI:1700537958
Name:CLOUT TREATMENT
Entity Type:Organization
Organization Name:CLOUT TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DESERAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TELLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-921-1481
Mailing Address - Street 1:2601 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-4131
Mailing Address - Country:US
Mailing Address - Phone:512-921-1481
Mailing Address - Fax:
Practice Address - Street 1:111 RAMBLE LN STE 120D
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-2278
Practice Address - Country:US
Practice Address - Phone:512-921-1481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty