MEDICARE: MR. DANIEL R. MCCLELLAN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	967	OK
2	106H00000X	Marriage & Family Therapist	2012012968	MO
3	106H00000X	Marriage & Family Therapist	M1010008	AR

General Provider Information

NPI Number	:	1467545665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL R. MCCLELLAN LMFT

Provider Business Mailing Address
First Line	:	PO BOX 5721
Second Line	:
City	:	BELLA VISTA
State	:	AR
Zip	:	72714-0721
Country	:	US
Telephone Number	:	918-810-8237
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 MCCLAIN RD SUITE 141
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72712-3875
Country	:	US
Telephone Number	:	918-810-8237
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	02/07/2024

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