| Doctor Name: | DR. GENE MCCONNACHIE |
| NPI Number: | 1023439106 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | PY00001806 |
| Business Practice Address: | 17440 Brookside Blvd Ne Lake Forest Park, WA - 981555528 |
| Business Phone Number: | 2064346334 |
| Business Fax Number: | |
| Mailing Address: | Po Box 292, SNOHOMISH |
| State: | WA |
| Postal Code: | 982910292 |
| Phone Number: | 2063482744 |
| Fax Number: | |
| NPI Enumeration Date: | 12/17/2013 |
| NPI Last Update Date: | 05/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY00001806 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |