Provider Demographics
NPI:1629280250
Name:CLANCY, SEREN MORRIS (LCPC, LPCC, LPAT)
Entity Type:Individual
Prefix:
First Name:SEREN
Middle Name:MORRIS
Last Name:CLANCY
Suffix:
Gender:F
Credentials:LCPC, LPCC, LPAT
Other - Prefix:
Other - First Name:LINNEA
Other - Middle Name:SERENDEE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1423 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5024
Mailing Address - Country:US
Mailing Address - Phone:208-345-2212
Mailing Address - Fax:208-345-2282
Practice Address - Street 1:1423 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5024
Practice Address - Country:US
Practice Address - Phone:208-345-2212
Practice Address - Fax:208-345-2282
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-5108101YP2500X
NM0122221101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional