Healthcare Provider Details

I. General information

NPI: 1528261393
Provider Name (Legal Business Name): BARBARA A MCCLUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 SANTA CLARA AVE SUITE 2
ALAMEDA CA
94501-4416
US

IV. Provider business mailing address

2233 SANTA CLARA AVE SUITE 2
ALAMEDA CA
94501-4416
US

V. Phone/Fax

Practice location:
  • Phone: 510-332-2552
  • Fax: 510-865-1930
Mailing address:
  • Phone: 510-332-2552
  • Fax: 510-865-1930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 38094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: