Provider Demographics
NPI:1770814758
Name:ALTUM, CLYDE S (MA, LPC, CACII)
Entity Type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:S
Last Name:ALTUM
Suffix:
Gender:M
Credentials:MA, LPC, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3287 95TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-4935
Mailing Address - Country:US
Mailing Address - Phone:720-297-2063
Mailing Address - Fax:
Practice Address - Street 1:14261 E 4TH AVE BLDG 6305
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8704
Practice Address - Country:US
Practice Address - Phone:720-297-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9681101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor