Healthcare Provider Details

I. General information

NPI: 1316393937
Provider Name (Legal Business Name): CLAYTON JAMES HARRISON JR. LMHC, LMFT, MCAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 03/02/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 W OAKLAND PARK BLVD
WILTON MANORS FL
33311-1731
US

IV. Provider business mailing address

1205 S FLAGLER AVE APT 411
POMPANO BEACH FL
33060-8696
US

V. Phone/Fax

Practice location:
  • Phone: 954-567-7141
  • Fax: 954-703-2029
Mailing address:
  • Phone: 216-338-8452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3769
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16297
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: