Provider Demographics
NPI:1346511953
Name:MARK D. CLAYTON LCSW PC
Entity Type:Organization
Organization Name:MARK D. CLAYTON LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-673-4870
Mailing Address - Street 1:PO BOX 3219
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84771-3219
Mailing Address - Country:US
Mailing Address - Phone:435-673-4870
Mailing Address - Fax:
Practice Address - Street 1:166 N 300 W
Practice Address - Street 2:STE 2
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2770
Practice Address - Country:US
Practice Address - Phone:435-673-4870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000075576Medicare Oscar/Certification