Provider Demographics
NPI:1508999319
Name:CLAY CROSSING FOUNDATION INC
Entity Type:Organization
Organization Name:CLAY CROSSING FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:N
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:ICADC
Authorized Official - Phone:405-374-1225
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:MAUD
Mailing Address - State:OK
Mailing Address - Zip Code:74854
Mailing Address - Country:US
Mailing Address - Phone:405-374-1225
Mailing Address - Fax:405-374-1258
Practice Address - Street 1:HWY 59 AND COUNTY CROSSROAD
Practice Address - Street 2:#EW133
Practice Address - City:MAUD
Practice Address - State:OK
Practice Address - Zip Code:74854
Practice Address - Country:US
Practice Address - Phone:405-374-1258
Practice Address - Fax:405-374-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health