Provider Demographics
NPI:1124372909
Name:PLOUFFE, KEITH A (LCPC)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:A
Last Name:PLOUFFE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 OLD LEWISTON RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-4121
Mailing Address - Country:US
Mailing Address - Phone:207-377-8122
Mailing Address - Fax:
Practice Address - Street 1:736 OLD LEWISTON RD
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-4121
Practice Address - Country:US
Practice Address - Phone:207-377-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional