Provider Demographics
NPI:1629460399
Name:DAVID C. CLINTON, P.C.
Entity Type:Organization
Organization Name:DAVID C. CLINTON, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:630-551-6063
Mailing Address - Street 1:1691 WINTER HILL CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-2910
Mailing Address - Country:US
Mailing Address - Phone:630-551-6063
Mailing Address - Fax:
Practice Address - Street 1:1691 WINTER HILL CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-2910
Practice Address - Country:US
Practice Address - Phone:630-551-6063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty