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General NPI Number Information
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NPI Number | 1407228547
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Entity Type | Individual
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Provider Name | CASEY CLAY
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Gender | Male
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 2865 OLD MAIN HL
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City | LOGAN
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State | UT
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Zip | 84322-2865
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Country | US
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Telephone | 435-797-3258
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Fax | 435-797-3258
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Provider Business Mailing Address
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Address Line | 205 PORTLAND ST
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City | COLUMBIA
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State | MO
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Zip | 65201-6521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 13490256-2506
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License Number State | UT
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