Healthcare Provider Details

I. General information

NPI: 1942654868
Provider Name (Legal Business Name): CADEY MCLELLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2016
Last Update Date: 04/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W MOANA LN
RENO NV
89509-4984
US

IV. Provider business mailing address

1580 KIRMAN AVE
RENO NV
89502-2933
US

V. Phone/Fax

Practice location:
  • Phone: 775-337-9357
  • Fax: 775-337-9360
Mailing address:
  • Phone: 775-544-7883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: