Healthcare Provider Details

I. General information

NPI: 1700336294
Provider Name (Legal Business Name): CLAYTON BEHAVIORAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 CLAYTON RD
SAINT LOUIS MO
63124-1685
US

IV. Provider business mailing address

9890 CLAYTON RD
SAINT LOUIS MO
63124-1685
US

V. Phone/Fax

Practice location:
  • Phone: 314-725-1515
  • Fax:
Mailing address:
  • Phone: 314-725-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: MR. NED PRESNALL
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, LCSW
Phone: 314-725-1515