MEDICARE: DR. CLAYTON EDWIN WIMBERLY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6057	CA

General Provider Information

NPI Number	:	1134386303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAYTON EDWIN WIMBERLY PH.D.

Provider Business Mailing Address
First Line	:	1187 COAST VILLAGE RD # 10
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-2737
Country	:	US
Telephone Number	:	805-969-5278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1187 COAST VILLAGE RD # 10
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-2737
Country	:	US
Telephone Number	:	805-969-5278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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