Provider Demographics
NPI:1356818777
Name:CLEAVENGER, MCKENSIE R (LMFT)
Entity Type:Individual
Prefix:
First Name:MCKENSIE
Middle Name:R
Last Name:CLEAVENGER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 BRADLEY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4500
Mailing Address - Country:US
Mailing Address - Phone:509-530-8716
Mailing Address - Fax:
Practice Address - Street 1:404 BRADLEY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4500
Practice Address - Country:US
Practice Address - Phone:509-530-8716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60975568106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist