Provider Demographics
NPI:1770920852
Name:FORENSIC AND CLINICAL PSYCHOLOGY SERVICES
Entity type:Organization
Organization Name:FORENSIC AND CLINICAL PSYCHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CODER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-455-2967
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:
Mailing Address - Fax:
Practice Address - Street 1:2820 NORTHUP WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1419
Practice Address - Country:US
Practice Address - Phone:425-455-2967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA754103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty