Healthcare Provider Details

I. General information

NPI: 1811306137
Provider Name (Legal Business Name): CLARE MCGINNESS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 STEILACOOM BLVD SW
LAKEWOOD WA
98498-7212
US

IV. Provider business mailing address

1507 44TH AVE SW
SEATTLE WA
98116-1618
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-7535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number60360376
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number60360376
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number60360376
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number60360376
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: