Provider Demographics
NPI:1689116410
Name:CLAY, CALEB
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:CLAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 W DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3629
Mailing Address - Country:US
Mailing Address - Phone:918-900-6237
Mailing Address - Fax:918-615-6493
Practice Address - Street 1:2208 W DETROIT ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3629
Practice Address - Country:US
Practice Address - Phone:918-900-6237
Practice Address - Fax:918-615-6493
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst