MEDICARE: CHELETTE MCCLENDON LCSW

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	1041C0700X	Clinical Social Worker	65259	TX

General Provider Information

NPI Number	:	1538891999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELETTE MCCLENDON LCSW

Provider Business Mailing Address
First Line	:	2600 VENTURA DR APT 1421
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4040
Country	:	US
Telephone Number	:	214-606-1646
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 BRAND STE 200
Second Line	:
City	:	MURPHY
State	:	TX
Zip	:	75094-3726
Country	:	US
Telephone Number	:	972-905-5549
Fax Number	:

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

Provider Enumeration Date	:	06/25/2022
Last Update Date	:	06/25/2022

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