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General NPI Number Information
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NPI Number | 1295398683
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Entity Type | Individual
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Provider Name | CLAYTON HOUSTON ALLRED
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Gender | Male
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Dates
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Enumeration Date | 04/21/2019
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Last Update Date | 04/21/2019
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Provider Practice Location Address
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Address Line | 2150 W CENTRAL AVE # LEVEL2
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City | TOLEDO
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State | OH
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Zip | 43606-3834
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Country | US
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Telephone | 291-419-7919
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Fax |
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Provider Business Mailing Address
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Address Line | 5727 TIBARON LN APT 311
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City | TOLEDO
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State | OH
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Zip | 43615-9264
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Country | US
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Telephone | 662-603-9054
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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