Provider Demographics
NPI:1164705695
Name:CLAYTON, GRETCHEN LEANE (LPC)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LEANE
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:
Other - Last Name:WRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:100 N ROCKINGCHAIR RD STE 1-3
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-2413
Mailing Address - Country:US
Mailing Address - Phone:870-335-9617
Mailing Address - Fax:870-335-9618
Practice Address - Street 1:100 N ROCKINGCHAIR RD STE 1-3
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2413
Practice Address - Country:US
Practice Address - Phone:870-335-9617
Practice Address - Fax:870-335-9618
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1103017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional