Healthcare Provider Details

I. General information

NPI: 1679167613
Provider Name (Legal Business Name): CLAYTON COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2021
Last Update Date: 02/20/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S LAKE AVE
PASADENA CA
91101-3005
US

IV. Provider business mailing address

944 N HOLLISTON AVE
PASADENA CA
91104-3012
US

V. Phone/Fax

Practice location:
  • Phone: 626-840-9793
  • Fax:
Mailing address:
  • Phone: 626-840-9793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CANDICE MICHELLE CLAYTON
Title or Position: CEO
Credential: LCSW
Phone: 626-840-9793