Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS-004325L | PA |
Y | 103T00000X | Psychologist | PS-004325L | PA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PS-004325L | PA |
NPI | 1023109469 |
---|---|
Provider Name | Lawrence T. Clayton |
First Address | State College, PA 16801-4849 |
Second Address | State College, PA 16801-4849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 09/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02622300 | CAPITAL BLUE CROSS (01) | PA |