Provider Demographics
NPI:1174705339
Name:WHITE, CLAIRE KELLY
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:KELLY
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:MARIE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2515 140TH AVE NE
Mailing Address - Street 2:SUITE E 110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1862
Mailing Address - Country:US
Mailing Address - Phone:425-644-4100
Mailing Address - Fax:877-302-7136
Practice Address - Street 1:2515 140TH AVE NE
Practice Address - Street 2:SUITE E 110
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1862
Practice Address - Country:US
Practice Address - Phone:425-644-4100
Practice Address - Fax:877-302-7136
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60411502103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist