Provider Demographics
NPI:1770832180
Name:WARD, COLIN CLAYTON (PHD)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:CLAYTON
Last Name:WARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 ISSAQUAH PINE LAKE RD SE
Mailing Address - Street 2:APT. V 11
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-6215
Mailing Address - Country:US
Mailing Address - Phone:206-303-9932
Mailing Address - Fax:
Practice Address - Street 1:2100 WESTLAKE AVE N
Practice Address - Street 2:SUITE 201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5802
Practice Address - Country:US
Practice Address - Phone:206-303-9932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60219898101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health