Provider Demographics
NPI:1730558966
Name:CLOE, KIM (MS,LPC)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:CLOE
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-2122
Mailing Address - Country:US
Mailing Address - Phone:318-855-3651
Mailing Address - Fax:318-855-3654
Practice Address - Street 1:110 FERNWOOD DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-2122
Practice Address - Country:US
Practice Address - Phone:318-855-3651
Practice Address - Fax:318-855-3654
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional