Provider Demographics
NPI:1023148269
Name:CRINEAN, WILLIAM JEFFREY (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JEFFREY
Last Name:CRINEAN
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 1:677 WOODLAND SQUARE LOOP SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1000
Mailing Address - Country:US
Mailing Address - Phone:360-451-0279
Mailing Address - Fax:360-459-9912
Practice Address - Street 1:677 WOODLAND SQUARE LOOP SE # 14
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1000
Practice Address - Country:US
Practice Address - Phone:360-451-0279
Practice Address - Fax:360-295-4589
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001360103T00000X, 103TB0200X, 103TC1900X, 103TC0700X
WAPY0001360103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0218559OtherLABOR AND INDUSTRY
WA0218559OtherLABOR AND INDUSTRY