Provider Demographics
NPI:1417907353
Name:CLANTON, LARRY DONALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DONALD
Last Name:CLANTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 PETTIGRU STREET
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601
Mailing Address - Country:US
Mailing Address - Phone:864-271-3549
Mailing Address - Fax:864-271-8282
Practice Address - Street 1:405 PETTIGRU STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601
Practice Address - Country:US
Practice Address - Phone:864-271-3549
Practice Address - Fax:864-271-8282
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-08-20
Deactivation Date:2006-05-29
Deactivation Code:
Reactivation Date:2007-08-20
Provider Licenses
StateLicense IDTaxonomies
SC570103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling