Provider Demographics
NPI:1518926336
Name:IRWIN CLAY, MARY E (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:IRWIN CLAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3291 S THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-7043
Mailing Address - Country:US
Mailing Address - Phone:479-751-3350
Mailing Address - Fax:
Practice Address - Street 1:3291 S THOMPSON ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7043
Practice Address - Country:US
Practice Address - Phone:479-751-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR91-20P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR7789378OtherAETNA
ARIRWCLAMEOtherCORP HEALTH
AR50047000000OtherQUAL CHOICE
AR7789378OtherAETNA