Provider Demographics
NPI:1346004850
Name:CLAYTON, JOHN B (ICADC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2267 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8532
Mailing Address - Country:US
Mailing Address - Phone:407-668-7834
Mailing Address - Fax:
Practice Address - Street 1:1275 N 400 E
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-8538
Practice Address - Country:US
Practice Address - Phone:208-271-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0702989101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)