Provider Demographics
NPI:1417520214
Name:CLAY BEHAVIORAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:CLAY BEHAVIORAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASST./ CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-291-5561
Mailing Address - Street 1:1726 KINGSLEY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4411
Mailing Address - Country:US
Mailing Address - Phone:904-278-5644
Mailing Address - Fax:
Practice Address - Street 1:1345 IDLEWILD AVE BLDG D
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-3804
Practice Address - Country:US
Practice Address - Phone:904-529-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAY BEHAVIORAL HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-20
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060411904Medicaid