Provider Demographics
NPI:1669529335
Name:CODER, CLARENCE RICHARD (PHD)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:RICHARD
Last Name:CODER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2820 NORTHUP WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1419
Mailing Address - Country:US
Mailing Address - Phone:425-455-2967
Mailing Address - Fax:866-230-8405
Practice Address - Street 1:MADIGAN ARMY MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:425-455-2967
Practice Address - Fax:866-230-8405
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA754103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical