Provider Demographics
NPI:1356802920
Name:CLAY, PARKER FORREST (BA, RBT)
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:FORREST
Last Name:CLAY
Suffix:
Gender:M
Credentials:BA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-3313
Mailing Address - Country:US
Mailing Address - Phone:434-960-9266
Mailing Address - Fax:
Practice Address - Street 1:9411 HICKORY ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-3313
Practice Address - Country:US
Practice Address - Phone:434-960-9266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician