Healthcare Provider Details

I. General information

NPI: 1396669503
Provider Name (Legal Business Name): ORVILLE LAWRENCE CLAYTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 HEWETT LN
MAITLAND FL
32751-3543
US

IV. Provider business mailing address

1931 HEWETT LN
MAITLAND FL
32751-3543
US

V. Phone/Fax

Practice location:
  • Phone: 754-270-4048
  • Fax:
Mailing address:
  • Phone: 754-270-4048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0002335
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0003248
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: