Healthcare Provider Details

I. General information

NPI: 1346511953
Provider Name (Legal Business Name): MARK D. CLAYTON LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 N 300 W STE 2
ST GEORGE UT
84770-2770
US

IV. Provider business mailing address

PO BOX 3219
ST GEORGE UT
84771-3219
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-4870
  • Fax:
Mailing address:
  • Phone: 435-673-4870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARK CLAYTON
Title or Position: PRESIDENT
Credential:
Phone: 435-673-4870