Healthcare Provider Details

I. General information

NPI: 1043855646
Provider Name (Legal Business Name): MAUREEN L MCCLELLAND LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10735 S CICERO AVE STE 208
OAK LAWN IL
60453-6214
US

IV. Provider business mailing address

9220 S HOYNE AVE
CHICAGO IL
60643-6303
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-0001
  • Fax:
Mailing address:
  • Phone: 773-505-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: