Provider Demographics
NPI:1619572401
Name:NIEMAN, CLINTON TYLER (LPC)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:TYLER
Last Name:NIEMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 N OGDEN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3813
Mailing Address - Country:US
Mailing Address - Phone:303-949-5198
Mailing Address - Fax:
Practice Address - Street 1:417 N OGDEN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3813
Practice Address - Country:US
Practice Address - Phone:303-949-5198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional