Provider Demographics
NPI:1164456315
Name:CLAY POT COUNSELING, INC.
Entity Type:Organization
Organization Name:CLAY POT COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SOPRON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-752-7016
Mailing Address - Street 1:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-0907
Mailing Address - Country:US
Mailing Address - Phone:307-752-7016
Mailing Address - Fax:
Practice Address - Street 1:2615 THREE OAKS RD STE 2A
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-6119
Practice Address - Country:US
Practice Address - Phone:307-752-7016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW5311041C0700X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY314353OtherBLUE CROSS BLUE SHIELD
IL396827550OtherBCBSIL
ILF100698449OtherMEDICARE NGS