Active NPI
Mildred Dean Clayton, MA, TLLP
- Psychologist
- Taylor, MI
National Provider Identifier
1104176932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301014637
- Practice address
- 25507 Ecorse Rd
Taylor, MI 48180-1555 - Phone
- (313) 292-7640
- Fax
- (313) 292-9270
- NPI assigned
- Sep 19, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301014637 | MI | Primary |
Addresses
Primary practice location
25507 Ecorse Rd
Taylor, MI 48180-1555
Mailing address
25507 Ecorse Rd
Taylor, MI 48180-1555
Phone (313) 292-7640
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301014637 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348012800000",
"number": "1104176932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25507 ECORSE RD",
"city": "TAYLOR",
"state": "MI",
"postal_code": "481801555",
"telephone_number": "313-292-7640",
"fax_number": "313-292-9270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25507 ECORSE RD",
"city": "TAYLOR",
"state": "MI",
"postal_code": "481801555",
"telephone_number": "313-292-7640",
"fax_number": "313-292-9270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLAYTON",
"first_name": "MILDRED",
"middle_name": "DEAN",
"credential": "MA, TLLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-19",
"last_updated": "2012-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301014637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Taylor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.