Healthcare Provider Details

I. General information

NPI: 1649542507
Provider Name (Legal Business Name): JOHN A MCLENDON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 VETERANS MEMORIAL BLVD
EUPORA MS
39744-2048
US

IV. Provider business mailing address

PO BOX 1188
STARKVILLE MS
39760-1188
US

V. Phone/Fax

Practice location:
  • Phone: 662-258-8147
  • Fax: 662-524-4370
Mailing address:
  • Phone: 662-524-4347
  • Fax: 662-524-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1802
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: