Healthcare Provider Details

I. General information

NPI: 1205998408
Provider Name (Legal Business Name): CRAIG ALAN MCCLUNG M.ED., AAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 16TH AVE E CAPITOL HILL NORTH
SEATTLE WA
98112-5212
US

IV. Provider business mailing address

1600 E OLIVE ST SEATTLE MENTAL HEALTH
SEATTLE WA
98122-2735
US

V. Phone/Fax

Practice location:
  • Phone: 206-302-2200
  • Fax: 206-302-2710
Mailing address:
  • Phone: 206-302-2200
  • Fax: 206-302-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60137322
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60137322
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: