Healthcare Provider Details

I. General information

NPI: 1336763796
Provider Name (Legal Business Name): PRECIOUS CLAYTOR LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4653 E MAIN ST
WHITEHALL OH
43213-3298
US

IV. Provider business mailing address

4928 FAIRWAY CT
COLUMBUS OH
43214-1730
US

V. Phone/Fax

Practice location:
  • Phone: 614-384-7703
  • Fax:
Mailing address:
  • Phone: 614-930-8086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2105945
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: