Provider Demographics
NPI:1508152604
Name:CLAY, DAMEON KRISTEN (MASTERS OF ART)
Entity Type:Individual
Prefix:
First Name:DAMEON
Middle Name:KRISTEN
Last Name:CLAY
Suffix:
Gender:M
Credentials:MASTERS OF ART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 N ROCKY POINT DR W STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-7200
Mailing Address - Country:US
Mailing Address - Phone:813-419-0026
Mailing Address - Fax:
Practice Address - Street 1:3030 N ROCKY POINT DR W STE 150
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-7200
Practice Address - Country:US
Practice Address - Phone:347-907-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
FL20935101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional