Clayton Willis, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1108 Poplar PL
Rogers, AR 72756-4249

Phone

(479) 372-6464

Fax

(479) 372-6460

NPI assigned

Sep 22, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1750004834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2809 FOREST HOME RD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724015320",
            "telephone_number": "866-972-1268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 POPLAR PL",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727564249",
            "telephone_number": "479-372-6464",
            "fax_number": "479-372-6460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "CLAYTON",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-22",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "238703795",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Ellen Williams, ANP
• Megan M Williams, MFT, LPC, RPT
• Tenley R Williams, PT, DPT
• Faith Williamson
• Whitney Leigh Williamson, DDS
• Jeremy Willis
• Anna Wilson
• Cynthia Renee Wilson, MD
• David Brian Wilson II
• Elizabeth A Wilson, APRN-CNP

• Mental Health Counselor in Rogers, AR
• Providers in Rogers, AR by specialty
• Mental Health Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.