Basic Information
| Provider Information | |||||||||
| NPI: | 1023148236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLUNE | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7507 NE51ST ST | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609061190 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7507 NE 51ST ST | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986626007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606016184 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 01/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LW00009168 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 3832 | OR | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.