Provider Demographics
NPI:1407036510
Name:CLATANOFF, ETIENNE (LPC)
Entity type:Individual
Prefix:
First Name:ETIENNE
Middle Name:
Last Name:CLATANOFF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 W 75TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3504
Mailing Address - Country:US
Mailing Address - Phone:913-543-1707
Mailing Address - Fax:
Practice Address - Street 1:2108 W 75TH ST STE D
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3504
Practice Address - Country:US
Practice Address - Phone:913-543-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008035370101YP2500X
KS2395101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional