Basic Information
Provider Information
NPI: 1730502097
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCCLANAHAN
FirstName: JUSTIN
MiddleName: CARL
NamePrefix:  
NameSuffix:  
Credential: DNP, PMHNP-BC, ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 202 N DIVISION ST STE 200
Address2:  
City: AUBURN
State: WA
PostalCode: 980014939
CountryCode: US
TelephoneNumber: 2536978400
FaxNumber:  
Practice Location
Address1: 202 N DIVISION ST STE 200
Address2:  
City: AUBURN
State: WA
PostalCode: 980014939
CountryCode: US
TelephoneNumber: 2536978400
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/22/2014
LastUpdateDate: 07/15/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808XAP 60423917WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


Home