Provider Demographics
NPI:1861680498
Name:LAWRENCE T. CLAYTON, PH.D., INC.
Entity Type:Organization
Organization Name:LAWRENCE T. CLAYTON, PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-234-3010
Mailing Address - Street 1:315 S ALLEN ST STE 218
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4850
Mailing Address - Country:US
Mailing Address - Phone:814-234-3010
Mailing Address - Fax:814-234-2170
Practice Address - Street 1:315 S ALLEN ST STE 218
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4850
Practice Address - Country:US
Practice Address - Phone:814-234-3010
Practice Address - Fax:814-234-2170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004325L251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA163684Medicare PIN