Basic Information
| Provider Information | |||||||||
| NPI: | 1205314747 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOUGLAS R CLAWSON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 481 E 1950 N | ||||||||
| Address2: | |||||||||
| City: | NORTH OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844143015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013173809 | ||||||||
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| Practice Location | |||||||||
| Address1: | 298 24TH ST STE 204 | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844011870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013173809 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2018 | ||||||||
| LastUpdateDate: | 03/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | CLAWSON | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | ROCKWELL | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 8013173809 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 03/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0850X | 6720347-3501 | UT | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 18173560 | 05 | UT | MEDICAID |