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General NPI Number Information
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NPI Number | 1417520214
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Entity Type | Organization
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Legal Business Name | CLAY BEHAVIORAL HEALTH CENTER, INC.
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 1345 IDLEWILD AVE BLDG D
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-3804
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Country | US
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Telephone | 904-529-2233
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Fax |
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Provider Business Mailing Address
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Address Line | 41 KNIGHT BOXX RD
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City | ORANGE PARK
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State | FL
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Zip | 32065-7305
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Country | US
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Telephone | 904-278-5644
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Fax |
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Authorized Official
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Title or Position | FISCAL RELATIONS SUPERVISOR
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Name | TERESA GASKINS
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Credential |
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Telephone | 904-291-5561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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