Provider Demographics
NPI:1073647236
Name:ALLEN, CLAYTON EDWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:EDWARD
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2001
Mailing Address - Country:US
Mailing Address - Phone:870-425-5559
Mailing Address - Fax:
Practice Address - Street 1:315 W 6TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653
Practice Address - Country:US
Practice Address - Phone:870-425-8642
Practice Address - Fax:870-425-8652
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3046C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160781526Medicaid