Provider Demographics
NPI:1245102466
Name:CLAY, TINA RENEE
Entity type:Individual
Prefix:MISS
First Name:TINA
Middle Name:RENEE
Last Name:CLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6061 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3818
Mailing Address - Country:US
Mailing Address - Phone:440-375-5342
Mailing Address - Fax:440-637-0330
Practice Address - Street 1:6061 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3818
Practice Address - Country:US
Practice Address - Phone:440-375-5342
Practice Address - Fax:440-637-0330
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005630175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist