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General NPI Number Information
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NPI Number | 1689052730
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Entity Type | Individual
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Provider Name | MICHAEL DANIEL EARLEY PHD
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Gender | Male
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Dates
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Enumeration Date | 05/09/2015
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Last Update Date | 05/09/2015
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Provider Practice Location Address
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Address Line | 307 S 13TH ST SUITE 200
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City | MOUNT VERNON
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State | WA
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Zip | 98274-4100
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Country | US
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Telephone | 360-419-3692
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Fax |
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Provider Business Mailing Address
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Address Line | 2017 H AVE
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City | ANACORTES
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State | WA
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Zip | 98221-3711
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Country | US
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Telephone | 206-755-0345
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60526571
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License Number State | WA
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