Provider Demographics
NPI:1992538078
Name:CLAY, CLARENCE LEE II (MS)
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:LEE
Last Name:CLAY
Suffix:II
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 PARKWAY CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-8032
Mailing Address - Country:US
Mailing Address - Phone:318-574-0098
Mailing Address - Fax:
Practice Address - Street 1:198 PARKWAY CIR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-8032
Practice Address - Country:US
Practice Address - Phone:318-574-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor