Provider Demographics
NPI:1518239052
Name:CLAYTON, INGRID (PHD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:INGRID
Other - Middle Name:
Other - Last Name:MATHIEU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1180 S BEVERLY DR STE 608
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1158
Mailing Address - Country:US
Mailing Address - Phone:310-229-5233
Mailing Address - Fax:
Practice Address - Street 1:1180 S BEVERLY DR STE 608
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1158
Practice Address - Country:US
Practice Address - Phone:310-229-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24799103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical