Provider Demographics
NPI:1972612687
Name:CLANCY, STEVE (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:CLANCY
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 1:10758 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-4812
Mailing Address - Country:US
Mailing Address - Phone:206-363-6553
Mailing Address - Fax:
Practice Address - Street 1:1604 HEWITT AVE 615
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3536
Practice Address - Country:US
Practice Address - Phone:425-770-2721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1238103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA52412Medicaid
WA52412Medicaid