Healthcare Provider Details

I. General information

NPI: 1285454504
Provider Name (Legal Business Name): THE CLAY HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 W CENTRAL AVE STE D
TOLEDO OH
43615-1510
US

IV. Provider business mailing address

1019 HARROW RD
TOLEDO OH
43615-4540
US

V. Phone/Fax

Practice location:
  • Phone: 419-512-1700
  • Fax:
Mailing address:
  • Phone: 419-360-9577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. SASHA CLAYBORNE
Title or Position: DIRECTOR
Credential:
Phone: 419-360-9577