MEDICARE: MR. CLARENCE LEE CLAY II MS

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	101Y00000X	Counselor		LA

General Provider Information

NPI Number	:	1992538078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CLARENCE LEE CLAY II MS

Provider Business Mailing Address
First Line	:	1000 CHINABERRY DR STE 900
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2455
Country	:	US
Telephone Number	:	318-202-3706
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 CHINABERRY DR STE 900
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2455
Country	:	US
Telephone Number	:	318-202-3706
Fax Number	:

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

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	01/14/2026

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