Provider Demographics
NPI:1942568647
Name:CLAY, KATHRYN FRANCES (MA, CAP, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:FRANCES
Last Name:CLAY
Suffix:
Gender:F
Credentials:MA, CAP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2810
Mailing Address - Country:US
Mailing Address - Phone:386-236-3200
Mailing Address - Fax:386-236-3178
Practice Address - Street 1:702 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5332
Practice Address - Country:US
Practice Address - Phone:386-236-3200
Practice Address - Fax:386-236-3178
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health