Healthcare Provider Details

I. General information

NPI: 1679520100
Provider Name (Legal Business Name): LARRY D. CLANTON, PH.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2006
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 PETTIGRU ST
GREENVILLE SC
29601-3114
US

IV. Provider business mailing address

405 PETTIGRU ST
GREENVILLE SC
29601-3114
US

V. Phone/Fax

Practice location:
  • Phone: 864-271-3549
  • Fax: 864-271-8282
Mailing address:
  • Phone: 864-271-3549
  • Fax: 864-271-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number570
License Number StateSC

VIII. Authorized Official

Name: DR. LARRY DONALD CLANTON
Title or Position: PSYCHOLOGIST (COUNSELING)
Credential: PH.D.
Phone: 864-271-3549