Provider Demographics
NPI:1598921140
Name:CLAYTON, TERI L (LMLP)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:L
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 DECATUR AVE N STE 109
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4363
Mailing Address - Country:US
Mailing Address - Phone:763-746-2400
Mailing Address - Fax:763-746-2401
Practice Address - Street 1:701 DECATUR AVE N STE 109
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4363
Practice Address - Country:US
Practice Address - Phone:176-374-6240
Practice Address - Fax:785-232-0160
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical