Provider Demographics
NPI:1033588181
Name:SNELL, CLAY
Entity Type:Individual
Prefix:
First Name:CLAY
Middle Name:
Last Name:SNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17533 W ROCK LEDGE RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-5723
Mailing Address - Country:US
Mailing Address - Phone:623-850-9242
Mailing Address - Fax:
Practice Address - Street 1:17533 W ROCK LEDGE RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-5723
Practice Address - Country:US
Practice Address - Phone:623-850-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6527993385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child