Basic Information
| Provider Information | |||||||||
| NPI: | 1306131628 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAYTON | ||||||||
| FirstName: | TERRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 E. CHURCH STREET | ||||||||
| Address2: | ATTENTION: MEDICAL STAFF OFFICE | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057393954 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 116 S PALISADE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057393968 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2011 | ||||||||
| LastUpdateDate: | 03/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 775227 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 163WP0808X | 775227 | CA | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 95011234 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.