Provider Demographics
NPI:1972763720
Name:MANNING, CLAYTON TODD (PHD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:TODD
Last Name:MANNING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HQ, 1ST SPECIAL FORCES GROUP (AIRBORNE)
Mailing Address - Street 2:BLDG 09937 GARFIELD ST.
Mailing Address - City:JOINT BASE LEWIS-MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98433-9500
Mailing Address - Country:US
Mailing Address - Phone:253-967-3102
Mailing Address - Fax:
Practice Address - Street 1:HQ, 1ST SPECIAL FORCES GROUP (AIRBORNE)
Practice Address - Street 2:BLDG 09937 GARFIELD ST.
Practice Address - City:JOINT BASE LEWIS-MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98433-9500
Practice Address - Country:US
Practice Address - Phone:253-967-3102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1490103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical