Basic Information
| Provider Information | |||||||||
| NPI: | 1043349533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | CLAYTON | ||||||||
| MiddleName: | |||||||||
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| Credential: | B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4378 W SAWMILL CT | ||||||||
| Address2: | |||||||||
| City: | CASTLE ROCK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801092843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036605568 | ||||||||
| FaxNumber: | 3034339717 | ||||||||
| Practice Location | |||||||||
| Address1: | 2829 W 33RD AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802113231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034333944 | ||||||||
| FaxNumber: | 3034339717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.