Provider Demographics
NPI:1215637079
Name:CLAMPITT, TIMOTHY RAY
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAY
Last Name:CLAMPITT
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 1:7215 E SILVERSTONE DR APT 3014
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4968
Mailing Address - Country:US
Mailing Address - Phone:310-622-2289
Mailing Address - Fax:
Practice Address - Street 1:611 N LEROUX ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3223
Practice Address - Country:US
Practice Address - Phone:928-235-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-21438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health