Healthcare Provider Details

I. General information

NPI: 1649819582
Provider Name (Legal Business Name): CLAY INTEGRATED HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 09/16/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N COMMERCE PARK DR STE 103
CINCINNATI OH
45215-3188
US

IV. Provider business mailing address

1 N COMMERCE PARK DR STE 103
CINCINNATI OH
45215-3188
US

V. Phone/Fax

Practice location:
  • Phone: 513-544-8813
  • Fax:
Mailing address:
  • Phone: 513-544-8813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDREA D YOUNG
Title or Position: CEO
Credential: PMHNP-BC
Phone: 513-544-8813