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General NPI Number Information
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NPI Number | 1811474877
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Entity Type | Individual
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Provider Name | CLAYTON LYNN SMITH LMSW
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Gender | Male
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 2463 E GALA ST STE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-5210
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Country | US
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Telephone | 208-201-9367
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Fax |
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Provider Business Mailing Address
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Address Line | 3322 UA AVE
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City | EMMETT
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State | ID
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Zip | 83617-9670
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Country | US
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Telephone | 208-201-9367
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LMSW-31518
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License Number State | ID
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