Provider Demographics
NPI:1306460738
Name:CLAY, HANNAH DARLINE (MSW)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:DARLINE
Last Name:CLAY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:DARLINE
Other - Last Name:EVENSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2532 COUNTY ROAD 21
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-8439
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2532 COUNTY ROAD 21
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-8439
Practice Address - Country:US
Practice Address - Phone:801-494-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0110122101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health