Provider Demographics
NPI:1376611384
Name:CLAYTON, MARK D (LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:CLAYTON
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:PO BOX 3219
Mailing Address - Street 2:
Mailing Address - City:SAINT 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:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2770
Practice Address - Country:US
Practice Address - Phone:435-673-4870
Practice Address - Fax:435-216-9403
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8813176835011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000075577Medicare Oscar/Certification