Provider Demographics
NPI:1861001778
Name:ISIMINGER, CLAYTON RYAN (LPC INTERN)
Entity Type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:RYAN
Last Name:ISIMINGER
Suffix:
Gender:M
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 GREENHOUSE RD STE 10
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6793
Mailing Address - Country:US
Mailing Address - Phone:361-857-4410
Mailing Address - Fax:
Practice Address - Street 1:3880 GREENHOUSE RD STE 10
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-6793
Practice Address - Country:US
Practice Address - Phone:281-900-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78741101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional