Provider Demographics
NPI:1932374816
Name:FELDMAN, CLYDE MYLES (PHD, LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:MYLES
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:PHD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 E PIMA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3664
Mailing Address - Country:US
Mailing Address - Phone:520-326-6060
Mailing Address - Fax:520-795-3575
Practice Address - Street 1:5210 E PIMA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3664
Practice Address - Country:US
Practice Address - Phone:520-326-6060
Practice Address - Fax:520-795-3575
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0421101YP2500X
AZLMFT-10055106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist