MEDICARE: KRISTIN COLLEEN CLOUSE MA-LMHC, LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH60340312	WA

General Provider Information

NPI Number	:	1184910291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN COLLEEN CLOUSE MA-LMHC, LPCC

Provider Business Mailing Address
First Line	:	115 HOUSTON AVE
Second Line	:
City	:	PARIS
State	:	KY
Zip	:	40361-1623
Country	:	US
Telephone Number	:	360-880-3501
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 HOUSTON AVE
Second Line	:
City	:	PARIS
State	:	KY
Zip	:	40361-1623
Country	:	US
Telephone Number	:	360-880-3501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	08/27/2020

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