Provider Demographics
NPI:1770903908
Name:HILL, CLINTON
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 W 106TH ST
Mailing Address - Street 2:APT 138
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-5920
Mailing Address - Country:US
Mailing Address - Phone:620-381-0351
Mailing Address - Fax:
Practice Address - Street 1:201 S MURRAY ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-2224
Practice Address - Country:US
Practice Address - Phone:580-371-0321
Practice Address - Fax:580-371-0131
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health