Healthcare Provider Details

I. General information

NPI: 1902071749
Provider Name (Legal Business Name): CLAY DENNIS SCOFIELD LPC, MA, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 W FRANKLIN RD SUITE 101
BOISE ID
83705-1079
US

IV. Provider business mailing address

605 11TH AVE E
GOODING ID
83330-5368
US

V. Phone/Fax

Practice location:
  • Phone: 208-336-9076
  • Fax: 208-336-9079
Mailing address:
  • Phone: 208-934-8461
  • Fax: 208-934-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC-96
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: