Provider Demographics
NPI:1891120440
Name:SELF, JOHN CLAY (LPC, LCDC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CLAY
Last Name:SELF
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 COUNTY ROAD 6711
Mailing Address - Street 2:
Mailing Address - City:NATALIA
Mailing Address - State:TX
Mailing Address - Zip Code:78059-2696
Mailing Address - Country:US
Mailing Address - Phone:210-776-4028
Mailing Address - Fax:
Practice Address - Street 1:743 COUNTY ROAD 6711
Practice Address - Street 2:
Practice Address - City:NATALIA
Practice Address - State:TX
Practice Address - Zip Code:78059-2696
Practice Address - Country:US
Practice Address - Phone:210-776-4028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5623101YA0400X
TX72206101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health