Provider Demographics
NPI:1922834134
Name:CLAY, SANTIANNA J (PLPC, MA)
Entity type:Individual
Prefix:
First Name:SANTIANNA
Middle Name:J
Last Name:CLAY
Suffix:
Gender:F
Credentials:PLPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9608 DULUTH DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63137-1348
Mailing Address - Country:US
Mailing Address - Phone:314-280-5044
Mailing Address - Fax:
Practice Address - Street 1:400 N 5TH ST STE 201
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1808
Practice Address - Country:US
Practice Address - Phone:636-238-2615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024007345101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health