Provider Demographics
NPI:1144225004
Name:CLOUD, NANCY (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CLOUD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98322-0159
Mailing Address - Country:US
Mailing Address - Phone:253-514-3050
Mailing Address - Fax:
Practice Address - Street 1:15570 DIAZ PL SW
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6703
Practice Address - Country:US
Practice Address - Phone:253-514-3005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS160561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS16056OtherLICENSED CLINICAL SW
CALCS16056OtherLICENSED CLINICAL SW