Crockett, Clay Justin

Crockett, Clay Justin is an sole proprietor health care provider with primary practice located at 1820 N 202Nd Ave , Buckeye AZ 85396-8712. He recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Psychiatric/Mental Health, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is his primary health care specialty. Crockett, Clay Justin can be contacted via phone (602) 820-3201.

Contact Information

Primary practice address
1820 N 202Nd Ave Buckeye AZ 85396-8712
Phone: (602) 820-3201
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Psychiatric/Mental Health 163WP0808X RN197246 Arizona
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 294847 Arizona

Profile Details

NPI number 1164120150
LBN Legal business name Crockett, Clay Justin
Credentials PMHNP-BC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 20th, 2023
Last updated Oct 6th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164120150 NPPES
Arizona MEDICAID 138626

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