Provider Demographics
NPI:1902490204
Name:PARNELL, CLARISSA JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:JANE
Last Name:PARNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14944 21ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1608
Mailing Address - Country:US
Mailing Address - Phone:206-251-1951
Mailing Address - Fax:
Practice Address - Street 1:13925 INTERURBAN AVE S STE 120
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-5718
Practice Address - Country:US
Practice Address - Phone:206-948-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3008339H103TS0200X
WA300839H103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3008339HOtherOFFICE OF PUBLIC INSTRUCTION WASHINGTON STATE