MEDICARE: KRISTAL CLAY

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	106S00000X	Behavior Technician		TX
2	106E00000X	Assistant Behavior Analyst		TX

General Provider Information

NPI Number	:	1851137335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTAL CLAY

Provider Business Mailing Address
First Line	:	1073 COUNTY ROAD 212 E
Second Line	:
City	:	HENDERSON
State	:	TX
Zip	:	75652-4026
Country	:	US
Telephone Number	:	903-918-3492
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 W MAIN ST
Second Line	:
City	:	HENDERSON
State	:	TX
Zip	:	75652-2836
Country	:	US
Telephone Number	:	903-918-3492
Fax Number	:

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

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	04/30/2025

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Directions to “ KRISTAL CLAY ” Practice Location

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