Provider Demographics
NPI:1104954114
Name:CLAYTON, MATTHEW D (LSCSW, LCMFT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:LSCSW, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-1538
Mailing Address - Country:US
Mailing Address - Phone:785-364-6561
Mailing Address - Fax:
Practice Address - Street 1:2000 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3340
Practice Address - Country:US
Practice Address - Phone:785-272-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS40911041C0700X
KSLCMFT684106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist