Provider Demographics
NPI:1063726362
Name:MCLEMORE, DOUGLAS ROY (M DIV)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ROY
Last Name:MCLEMORE
Suffix:
Gender:M
Credentials:M DIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1192
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-1192
Mailing Address - Country:US
Mailing Address - Phone:360-692-9524
Mailing Address - Fax:
Practice Address - Street 1:9125 CENTRAL VALLEY RD. N.W.
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-9157
Practice Address - Country:US
Practice Address - Phone:360-692-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral