Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1306181425 |
---|---|
Provider Name | Clayton Ryan Tuttle |
First Address | Henderson, NV 89014-7633 |
Second Address | Henderson, NV 89014-7633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2012 |
Last Update Date | 29/11/2012 |