Provider Demographics
NPI:1518622034
Name:MARKWELL, CLAYTON (ACD0002396)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:
Last Name:MARKWELL
Suffix:
Gender:M
Credentials:ACD0002396
Other - Prefix:
Other - First Name:CLAY
Other - Middle Name:
Other - Last Name:MARKWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, LPCC
Mailing Address - Street 1:3766 YATES ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2041
Mailing Address - Country:US
Mailing Address - Phone:312-203-6382
Mailing Address - Fax:
Practice Address - Street 1:3766 YATES ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2041
Practice Address - Country:US
Practice Address - Phone:312-203-6382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACA.0008145101YA0400X
COACD.0002396101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)