Provider Demographics
NPI:1952711277
Name:CLOVIS, CLINTON (MHC)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:
Last Name:CLOVIS
Suffix:
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:CLINTON
Other - Middle Name:
Other - Last Name:CLOVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHC
Mailing Address - Street 1:14706 230TH PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-4433
Mailing Address - Country:US
Mailing Address - Phone:646-429-2709
Mailing Address - Fax:
Practice Address - Street 1:14706 230TH PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-4433
Practice Address - Country:US
Practice Address - Phone:646-429-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health