Provider Demographics
NPI:1871646216
Name:CLOUTIER, KYLE GREGORY (LICSW)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:GREGORY
Last Name:CLOUTIER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
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Mailing Address - Street 1:PO BOX 240125
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-0125
Mailing Address - Country:US
Mailing Address - Phone:952-334-8278
Mailing Address - Fax:952-891-4258
Practice Address - Street 1:1120 CENTRE POINTE DR STE 100
Practice Address - Street 2:#100
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1275
Practice Address - Country:US
Practice Address - Phone:952-334-8278
Practice Address - Fax:952-891-4258
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN139761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN505K6CLOtherBLUE CROSS BLUE SHIELD
MN114510OtherHEALTH PARTNERS
NY556368OtherVALUE OPTIONS