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General NPI Number Information
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NPI Number | 1720702749
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Entity Type | Organization
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Legal Business Name | MCKENSIE CLEAVENGER THERAPY, LLC
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 404 BRADLEY BLVD STE 200
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City | RICHLAND
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State | WA
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Zip | 99352-4500
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Country | US
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Telephone | 509-530-8716
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Fax |
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Provider Business Mailing Address
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Address Line | 404 BRADLEY BLVD STE 200
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City | RICHLAND
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State | WA
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Zip | 99352-4500
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Country | US
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Telephone | 509-530-8716
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Fax |
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Authorized Official
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Title or Position | PROVIDER/SOLE OWNER
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Name | MCKENSIE CLEAVENGER
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Credential |
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Telephone | 509-530-8716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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