Individual
JACOB THADDEUS CLAYTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
106 THREE RIVERS N, FORT WAYNE, IN 46802-1312
(260) 426-5778
Mailing address
106 THREE RIVERS N, FORT WAYNE, IN 46802-1312
(260) 426-5778
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
34005012A
IN
Other
Enumeration date
08/16/2005
Last updated
07/08/2007
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