Healthcare Provider Details

I. General information

NPI: 1013357953
Provider Name (Legal Business Name): COUNTY OF CLAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S ARCHER ST
HENRIETTA TX
76365-2746
US

IV. Provider business mailing address

102 S ARCHER ST
HENRIETTA TX
76365-2746
US

V. Phone/Fax

Practice location:
  • Phone: 940-538-0454
  • Fax: 940-235-3449
Mailing address:
  • Phone: 940-538-0454
  • Fax: 940-235-3449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBRA HAEHN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 940-538-5621