Provider Demographics
NPI:1649518903
Name:RUNDELL, CLAYTON WHITE (LPC)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:WHITE
Last Name:RUNDELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 E KING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-5306
Mailing Address - Country:US
Mailing Address - Phone:717-393-3900
Mailing Address - Fax:717-393-7900
Practice Address - Street 1:36 E KING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-5306
Practice Address - Country:US
Practice Address - Phone:717-393-3900
Practice Address - Fax:717-393-7900
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006736101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional