Provider Demographics
NPI:1427615863
Name:CLINTON, EMMANUEL N
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:N
Last Name:CLINTON
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 1:8417 REGENT AVE N APT 317
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2262
Mailing Address - Country:US
Mailing Address - Phone:612-432-0242
Mailing Address - Fax:
Practice Address - Street 1:STE CONSULTANTS, LLC
Practice Address - Street 2:3650 MT DIABLO BLVD., SUITE 107
Practice Address - City:LAFEYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549
Practice Address - Country:US
Practice Address - Phone:510-665-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician