Provider Demographics
NPI:1821187261
Name:KALOUDIS, KATHLEEN (LCMHC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:KALOUDIS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71051
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-0051
Mailing Address - Country:US
Mailing Address - Phone:801-201-7050
Mailing Address - Fax:801-880-1508
Practice Address - Street 1:7105 S HIGHLAND DR STE 202
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-7321
Practice Address - Country:US
Practice Address - Phone:801-201-7050
Practice Address - Fax:801-880-1508
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17837101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158041701OtherMEDICAID
TX158041702Medicaid