Healthcare Provider Details

I. General information

NPI: 1003384728
Provider Name (Legal Business Name): LANA LEIGH CLAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 HANLEY RD
OCEAN SPRINGS MS
39564-3118
US

IV. Provider business mailing address

1104 HANLEY RD
OCEAN SPRINGS MS
39564-3118
US

V. Phone/Fax

Practice location:
  • Phone: 850-572-8366
  • Fax:
Mailing address:
  • Phone: 850-572-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberQASPS10490
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT1867639
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-48233
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: