Healthcare Provider Details

I. General information

NPI: 1255254140
Provider Name (Legal Business Name): MOLLY MCCLELLAN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 E 16TH ST
INDIANAPOLIS IN
46219-2503
US

IV. Provider business mailing address

908 EASTERN AVE
INDIANAPOLIS IN
46201-2120
US

V. Phone/Fax

Practice location:
  • Phone: 812-606-7442
  • Fax:
Mailing address:
  • Phone: 812-606-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33013947A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: