Provider Demographics
NPI:1518331750
Name:R. DENISE CLAY LLC
Entity Type:Organization
Organization Name:R. DENISE CLAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL CLINICAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCHELL
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPCC, NCC
Authorized Official - Phone:505-306-4060
Mailing Address - Street 1:9200 SPAIN RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2212
Mailing Address - Country:US
Mailing Address - Phone:505-306-4060
Mailing Address - Fax:
Practice Address - Street 1:4011 BARBARA LOOP SE
Practice Address - Street 2:SUITE #107
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1039
Practice Address - Country:US
Practice Address - Phone:505-306-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-28
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0177271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM19339577Medicaid