Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ACC-7301 | CO |
NPI | 1003151408 |
---|---|
Provider Name | Scott D Clawson |
First Address | Greeley, CO 80631-9584 |
Second Address | Greeley, CO 80631-9584 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2012 |
Last Update Date | 11/12/2012 |