Healthcare Provider Details

I. General information

NPI: 1043349533
Provider Name (Legal Business Name): CLAYTON SMITH B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 W 33RD AVE
DENVER CO
80211-3231
US

IV. Provider business mailing address

4378 W SAWMILL CT
CASTLE ROCK CO
80109-2843
US

V. Phone/Fax

Practice location:
  • Phone: 303-433-3944
  • Fax: 303-433-9717
Mailing address:
  • Phone: 303-660-5568
  • Fax: 303-433-9717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: