Provider Demographics
NPI:1679696777
Name:CLINCAL & FORENSIC PSYCHOLOGY, INC., P.S.
Entity Type:Organization
Organization Name:CLINCAL & FORENSIC PSYCHOLOGY, INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:WHITEHILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:253-984-7686
Mailing Address - Street 1:3815 100TH ST SW
Mailing Address - Street 2:STE 2B
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4401
Mailing Address - Country:US
Mailing Address - Phone:253-984-7686
Mailing Address - Fax:253-984-7862
Practice Address - Street 1:3815 100TH ST SW
Practice Address - Street 2:STE 2B
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4401
Practice Address - Country:US
Practice Address - Phone:253-984-7686
Practice Address - Fax:253-984-7862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty