=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275418063
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. LAUREN ASHLEA CLAY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2025
-----------------------------------------------------
Last Update Date | 08/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7300 AIRWAYS BLVD
-----------------------------------------------------
City | SOUTHAVEN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38671-5839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-448-3232
-----------------------------------------------------
Fax | 662-490-3723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9391 HONEY SUCKLE WAY
-----------------------------------------------------
City | HERNANDO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38632-4451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-805-2467
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-21-52942
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------