Provider Demographics
NPI:1851479885
Name:CLAY, BRUCE E (MA)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:E
Last Name:CLAY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HOSPITAL DR
Mailing Address - Street 2:STE# 106
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9237
Mailing Address - Country:US
Mailing Address - Phone:304-757-8650
Mailing Address - Fax:304-757-0633
Practice Address - Street 1:1401 HOSPITAL DR
Practice Address - Street 2:STE# 106
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9237
Practice Address - Country:US
Practice Address - Phone:304-757-8650
Practice Address - Fax:304-757-0633
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV384103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0164604000Medicaid
WVCL0817271Medicare ID - Type UnspecifiedMEDICARE ID #