Provider Demographics
NPI:1821780081
Name:CLAYTON, BRYANT KEITH JR (PSYD)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:KEITH
Last Name:CLAYTON
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 BRAESMAIN DR APT 3307
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2956
Mailing Address - Country:US
Mailing Address - Phone:317-306-9475
Mailing Address - Fax:
Practice Address - Street 1:4119 MONTROSE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-4970
Practice Address - Country:US
Practice Address - Phone:317-306-9475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39853103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical