Basic Information
| Provider Information | |||||||||
| NPI: | 1437616760 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLOUFFE | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | JEANETTA | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 E DEUCE OF CLUBS | ||||||||
| Address2: | |||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859014808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285323926 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 320 E DEUCE OF CLUBS | ||||||||
| Address2: | |||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859014808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285323926 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2019 | ||||||||
| LastUpdateDate: | 02/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC008297 | GA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | LPC-17881 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.