Provider Demographics
NPI:1336490374
Name:CLINICAL AND NEUROPSYCHOLOGICAL SERVICES, INC
Entity Type:Organization
Organization Name:CLINICAL AND NEUROPSYCHOLOGICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELGA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNEAR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:206-321-9391
Mailing Address - Street 1:1621 FREEWAY DR STE 200
Mailing Address - Street 2:TRIDEX PROFESSIONAL BUILDING
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2462
Mailing Address - Country:US
Mailing Address - Phone:206-321-9391
Mailing Address - Fax:
Practice Address - Street 1:87 SWINOMISH DR
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-9634
Practice Address - Country:US
Practice Address - Phone:206-321-9391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60263822251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health