Individual
CLINTON THOMAS MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2432 W PEORIA AVE STE 1114, PHOENIX, AZ 85029-4732
(602) 999-0028
Mailing address
2432 W PEORIA AVE STE 1114, PHOENIX, AZ 85029-4732
(602) 999-0028
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
86-0586210
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D05124188
IDENTIFICATION CARD
AZ
Enumeration date
08/31/2022
Last updated
08/31/2022
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