Provider Demographics
NPI:1275407413
Name:CLEMENTS, CODY
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 S FRUITVALE RD UNIT B1
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-5387
Mailing Address - Country:US
Mailing Address - Phone:509-308-5672
Mailing Address - Fax:
Practice Address - Street 1:1212 N WASHINGTON ST STE 327
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2403
Practice Address - Country:US
Practice Address - Phone:509-505-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health