Provider Demographics
NPI:1144808825
Name:PSOMADELIS, CLOE (LMHC)
Entity type:Individual
Prefix:
First Name:CLOE
Middle Name:
Last Name:PSOMADELIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 IMPERIAL RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8709
Mailing Address - Country:US
Mailing Address - Phone:219-246-0504
Mailing Address - Fax:
Practice Address - Street 1:677 FRIARS GRN
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-7776
Practice Address - Country:US
Practice Address - Phone:219-510-2564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004748A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health