Healthcare Provider Details

I. General information

NPI: 1518884840
Provider Name (Legal Business Name): BRYCE CAMERON CLAYTON ACMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 N MAIN ST STE 203
TOOELE UT
84074-9839
US

IV. Provider business mailing address

1244 N MAIN ST STE 203
TOOELE UT
84074-9839
US

V. Phone/Fax

Practice location:
  • Phone: 435-882-4354
  • Fax:
Mailing address:
  • Phone: 435-882-4354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7554362-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: