Healthcare Provider Details

I. General information

NPI: 1902131477
Provider Name (Legal Business Name): HEATHER MCCLELLAND LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5367 STONEBRIAR CIR
DURANT OK
74701-1702
US

IV. Provider business mailing address

5367 STONEBRIAR CIR
DURANT OK
74701-1702
US

V. Phone/Fax

Practice location:
  • Phone: 580-371-3672
  • Fax: 580-371-3651
Mailing address:
  • Phone: 580-371-3672
  • Fax: 580-371-3651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4219
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: