Provider Demographics
NPI:1871216028
Name:CLOUTIER-CHENIER, JUDITH JOELLE I (LAC)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:JOELLE
Last Name:CLOUTIER-CHENIER
Suffix:I
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 N. TATUM BLVD
Mailing Address - Street 2:STE 102 PMB 949
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6070
Mailing Address - Country:US
Mailing Address - Phone:704-340-3568
Mailing Address - Fax:
Practice Address - Street 1:8348 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:704-340-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20583101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor