=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013357953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF CLAY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2013
-----------------------------------------------------
Last Update Date | 12/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 S ARCHER ST
-----------------------------------------------------
City | HENRIETTA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76365-2746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-538-0454
-----------------------------------------------------
Fax | 940-235-3449
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 S ARCHER ST
-----------------------------------------------------
City | HENRIETTA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76365-2746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-538-0454
-----------------------------------------------------
Fax | 940-235-3449
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | DEBRA HAEHN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 940-538-5621
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------