MEDICARE: MR. CLAY STEPHEN CAMP LPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1614	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164440798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CLAY STEPHEN CAMP LPA

Provider Business Mailing Address
First Line	:	7025 HWY 16 SOUTH
Second Line	:
City	:	JEFFERSON
State	:	NC
Zip	:	28640
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4660 HIGH ROCK ROAD
Second Line	:
City	:	BOOMER
State	:	NC
Zip	:	28606
Country	:	US
Telephone Number	:	336-977-1794
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	04/01/2021

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