Healthcare Provider Details

I. General information

NPI: 1104462092
Provider Name (Legal Business Name): AMBER D CLAYTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MISSILE AVE
MINOT AFB ND
58705-5003
US

IV. Provider business mailing address

10 MISSILE AVE
MINOT AFB ND
58705-5003
US

V. Phone/Fax

Practice location:
  • Phone: 951-210-4451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012375
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: