Provider Demographics
NPI:1699186825
Name:CLAYTON, JULIE A (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 BEAUMONT ST
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-3132
Mailing Address - Country:US
Mailing Address - Phone:618-920-5212
Mailing Address - Fax:618-462-3829
Practice Address - Street 1:611 W DELMAR AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4214
Practice Address - Country:US
Practice Address - Phone:618-920-5212
Practice Address - Fax:618-462-3829
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2014-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional