MEDICARE: COLIN CLAYTON WARD PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH 60219898	WA

General Provider Information

NPI Number	:	1770832180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLIN CLAYTON WARD PH.D.

Provider Business Mailing Address
First Line	:	4425 ISSAQUAH PINE LAKE RD SE
Second Line	:	APT. V 11
City	:	ISSAQUAH
State	:	WA
Zip	:	98075-6215
Country	:	US
Telephone Number	:	206-303-9932
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 WESTLAKE AVE N
Second Line	:	SUITE 201
City	:	SEATTLE
State	:	WA
Zip	:	98109-5802
Country	:	US
Telephone Number	:	206-303-9932
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	08/30/2012

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