Provider Demographics
NPI:1376985028
Name:CLAY, LAURA ANN (LCPC, ATR)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:CLAY
Suffix:
Gender:F
Credentials:LCPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 MAPLE AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4136
Mailing Address - Country:US
Mailing Address - Phone:630-999-8236
Mailing Address - Fax:
Practice Address - Street 1:1440 MAPLE AVE STE 2B
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4136
Practice Address - Country:US
Practice Address - Phone:630-999-8236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional