Healthcare Provider Details

I. General information

NPI: 1336399955
Provider Name (Legal Business Name): WILLIAM CORBELL MCKAY M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 MISSION HILL RD
TULALIP WA
98271-9706
US

IV. Provider business mailing address

2821 MISSION HILL RD
TULALIP WA
98271-9706
US

V. Phone/Fax

Practice location:
  • Phone: 360-716-4326
  • Fax: 360-651-4404
Mailing address:
  • Phone: 360-716-4326
  • Fax: 360-651-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH 00003498
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: