Basic Information
| Provider Information | |||||||||
| NPI: | 1215226790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLOUNCH | ||||||||
| FirstName: | KRISTOPHER | ||||||||
| MiddleName: | LUERON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2216 S MIAMI BLVD | ||||||||
| Address2: | STE 103 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277036281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198060509 | ||||||||
| FaxNumber: | 8668208694 | ||||||||
| Practice Location | |||||||||
| Address1: | 2216 S MIAMI BLVD | ||||||||
| Address2: | STE 103 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277036281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198060509 | ||||||||
| FaxNumber: | 8668208694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2011 | ||||||||
| LastUpdateDate: | 04/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 4100 | NC | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.