Provider Demographics
NPI:1205010766
Name:VANCLEAVE, RICHARD L (LMHC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:VANCLEAVE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ISRAEL RD SE # 14404
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6458
Mailing Address - Country:US
Mailing Address - Phone:360-401-3051
Mailing Address - Fax:360-401-3051
Practice Address - Street 1:200 ISRAEL RD SE # 14404
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6458
Practice Address - Country:US
Practice Address - Phone:360-401-3051
Practice Address - Fax:360-401-3051
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00032146101YM0800X
WA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health