Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY 60235386 | WA |
N | 103TC0700X | Clinical Psychologist | PY 60235386 | WA |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PY 60235386 | WA |
NPI | 1083847883 |
---|---|
Provider Name | Courtney A Clinton |
First Address | Everett, WA 98201 |
Second Address | Everett, WA 98201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2009 |
Last Update Date | 04/09/2012 |