Basic Information
| Provider Information | |||||||||
| NPI: | 1154610954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLAMO | ||||||||
| FirstName: | TORI | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | LPCC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GAHN | ||||||||
| OtherFirstName: | TORI | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10101 LINN STATION RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402233848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025898600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4710 CHAMPIONS TRACE LN | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402183495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5027363051 | ||||||||
| FaxNumber: | 5027363052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2011 | ||||||||
| LastUpdateDate: | 11/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 104525 | KY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.