Provider Demographics
NPI:1871952747
Name:SIMS, CLAYTON LENNON
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:LENNON
Last Name:SIMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N27W23957 PAUL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-6223
Mailing Address - Country:US
Mailing Address - Phone:262-278-4462
Mailing Address - Fax:
Practice Address - Street 1:N27W23957 PAUL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-6223
Practice Address - Country:US
Practice Address - Phone:262-278-4462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15618131101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI15618131OtherSTATE LICENSE