Provider Demographics
NPI:1831068774
Name:HALL, CLAYTON REED
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:REED
Last Name:HALL
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 1:675 E ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-2020
Mailing Address - Country:US
Mailing Address - Phone:208-432-1976
Mailing Address - Fax:
Practice Address - Street 1:675 E ANDERSON ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-2020
Practice Address - Country:US
Practice Address - Phone:208-432-1976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health