Provider Demographics
NPI:1184353955
Name:CLAYSON, EMERY EUGENE (PSYD)
Entity type:Individual
Prefix:DR
First Name:EMERY
Middle Name:EUGENE
Last Name:CLAYSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 S GARTH ST
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-8829
Mailing Address - Country:US
Mailing Address - Phone:760-793-9174
Mailing Address - Fax:
Practice Address - Street 1:4632 TAHOE PL
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83202-2632
Practice Address - Country:US
Practice Address - Phone:760-793-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool