Provider Demographics
NPI:1528608361
Name:CLAYTON, HARRY TYRELL (LCSW)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:TYRELL
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 IRON BRIDGE RD STE 31
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6455
Mailing Address - Country:US
Mailing Address - Phone:804-243-9150
Mailing Address - Fax:804-715-4358
Practice Address - Street 1:7107 KOUFAX CT
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-8217
Practice Address - Country:US
Practice Address - Phone:804-243-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040114381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical