Provider Demographics
NPI:1811217276
Name:CLAY POPLIN LCSW, LLC
Entity Type:Organization
Organization Name:CLAY POPLIN LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:POPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-284-2029
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-0392
Mailing Address - Country:US
Mailing Address - Phone:816-284-2029
Mailing Address - Fax:816-632-8228
Practice Address - Street 1:607 LANA DR
Practice Address - Street 2:SUITE C
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-1392
Practice Address - Country:US
Practice Address - Phone:816-284-2029
Practice Address - Fax:816-632-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20101260400261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)