Provider Demographics
NPI:1952911307
Name:CLAYSON, KELSI ANN (PSYD)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:ANN
Last Name:CLAYSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KELSI
Other - Middle Name:ANN
Other - Last Name:UMEKUBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:20747 STERLINGTON DR.
Mailing Address - Street 2:
Mailing Address - City:LAND O' LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-4317
Mailing Address - Country:US
Mailing Address - Phone:813-702-3326
Mailing Address - Fax:
Practice Address - Street 1:20747 STERLINGTON DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-4317
Practice Address - Country:US
Practice Address - Phone:813-702-3326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10776103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical