MEDICARE: TERRANCE CLAY BCBA,LBA

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	103K00000X	Behavior Analyst	LBA002638	GA

General Provider Information

NPI Number	:	1316881279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRANCE CLAY BCBA,LBA

Provider Business Mailing Address
First Line	:	2443 DEER SPRINGS CT
Second Line	:
City	:	ELLENWOOD
State	:	GA
Zip	:	30294-1170
Country	:	US
Telephone Number	:	321-558-0191
Fax Number	:

Provider Business Practice Location Address
First Line	:	2443 DEER SPRINGS CT
Second Line	:
City	:	ELLENWOOD
State	:	GA
Zip	:	30294-1170
Country	:	US
Telephone Number	:	321-558-0191
Fax Number	:

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

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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