Individual
CLAY R STACY
Active
Individual
CLAY R STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2017043729
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14480990
CAQH
MO
01
—
2020012248
STATE LICENSE
MO
05
—
490074582
—
MO
Enumeration date
06/07/2019
Last updated
12/07/2020
Update your record
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