Provider Demographics
NPI:1982074225
Name:CLAYTON, TAKYMMEA (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:TAKYMMEA
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-0803
Mailing Address - Country:US
Mailing Address - Phone:601-773-5051
Mailing Address - Fax:601-773-5546
Practice Address - Street 1:2318 B ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-5931
Practice Address - Country:US
Practice Address - Phone:601-773-5051
Practice Address - Fax:601-773-5546
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6279103T00000X
TN3707103T00000X
MIL957315390200000X
MS601060103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05670031Medicaid