MEDICARE: CLAY HAVEN PSYCHIATRY

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1538916630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAY HAVEN PSYCHIATRY

Provider Business Mailing Address
First Line	:	1824 BRIARROSE CT
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-1907
Country	:	US
Telephone Number	:	513-520-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1824 BRIARROSE CT
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-1907
Country	:	US
Telephone Number	:	513-520-4100
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIC NURSE PRACTITIONER
Name	:	KELLIE CLAY
Credential	:
Telephone Number	:	513-520-4100

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	05/06/2024

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