Provider Demographics
NPI:1770887796
Name:CLAYCOMB, BRETON JAMES (ME)
Entity type:Individual
Prefix:
First Name:BRETON
Middle Name:JAMES
Last Name:CLAYCOMB
Suffix:
Gender:M
Credentials:ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3759 BUSINESS ROUTE 220
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-1130
Mailing Address - Country:US
Mailing Address - Phone:813-623-1212
Mailing Address - Fax:814-285-3023
Practice Address - Street 1:131 MARKET ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1628
Practice Address - Country:US
Practice Address - Phone:814-623-1212
Practice Address - Fax:814-285-3023
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health