Provider Demographics
NPI:1881243590
Name:BILL CLAFTON PSYD LP LLC
Entity type:Organization
Organization Name:BILL CLAFTON PSYD LP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:CLAFTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD LP
Authorized Official - Phone:651-385-9131
Mailing Address - Street 1:1755 OLD WEST MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-3057
Mailing Address - Country:US
Mailing Address - Phone:651-385-9131
Mailing Address - Fax:651-385-9141
Practice Address - Street 1:1755 OLD WEST MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-3057
Practice Address - Country:US
Practice Address - Phone:651-385-9131
Practice Address - Fax:651-385-9141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty