Healthcare Provider Details

I. General information

NPI: 1023886546
Provider Name (Legal Business Name): CLAUSSEN COLLABORATIVE MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 STILLWATER DR
PRESCOTT AZ
86305-7173
US

IV. Provider business mailing address

2020 SUMMER VIEW DR
PRESCOTT AZ
86301-8129
US

V. Phone/Fax

Practice location:
  • Phone: 928-277-0875
  • Fax:
Mailing address:
  • Phone: 928-499-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. SPENCER JAMES CLAUSSEN
Title or Position: PRESIDENT
Credential: FNP, PMHNP
Phone: 928-499-0787