Provider Demographics
NPI:1972128890
Name:CLARK, CLAYTON ADAM (MED)
Entity Type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:ADAM
Last Name:CLARK
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S BEMISTON AVE STE 920
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1907
Mailing Address - Country:US
Mailing Address - Phone:314-413-9249
Mailing Address - Fax:
Practice Address - Street 1:230 S BEMISTON AVE STE 920
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1907
Practice Address - Country:US
Practice Address - Phone:314-413-9249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health