Provider Demographics
NPI:1639290620
Name:NEWELL, CLINTON PATRICK (LPCC)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:PATRICK
Last Name:NEWELL
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:MR
Other - First Name:CLINT
Other - Middle Name:PATRICK
Other - Last Name:NEWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:72925 FRED WARING DR STE 201
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-9405
Mailing Address - Country:US
Mailing Address - Phone:760-895-1616
Mailing Address - Fax:760-334-8715
Practice Address - Street 1:72925 FRED WARING DR STE 201
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9405
Practice Address - Country:US
Practice Address - Phone:760-895-1616
Practice Address - Fax:760-334-8715
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25101Y00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876000308007Medicaid