Basic Information
| Provider Information | |||||||||
| NPI: | 1922263250 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAYTON | ||||||||
| FirstName: | KELLI | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | MS, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 S BON VIEW AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917614408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099306793 | ||||||||
| FaxNumber: | 9099306798 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 S BON VIEW AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917614408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099306793 | ||||||||
| FaxNumber: | 9099306798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2008 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 53696 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.