Provider Demographics
NPI:1801041322
Name:BILBRAY, CLARENCE E (LMHC)
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:E
Last Name:BILBRAY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 VANDERFORD RD N
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5968
Mailing Address - Country:US
Mailing Address - Phone:904-215-0063
Mailing Address - Fax:
Practice Address - Street 1:3810-3 WILLIAMSBURG PARK BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-9220
Practice Address - Country:US
Practice Address - Phone:904-419-6102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health