Provider Demographics
NPI:1811555204
Name:CLAYTON, TARIANNA ALICE
Entity Type:Individual
Prefix:
First Name:TARIANNA
Middle Name:ALICE
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 BERCUT DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-0115
Mailing Address - Country:US
Mailing Address - Phone:916-443-2479
Mailing Address - Fax:916-443-2477
Practice Address - Street 1:610 BERCUT DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-0115
Practice Address - Country:US
Practice Address - Phone:916-443-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician