Healthcare Provider Details

I. General information

NPI: 1922356088
Provider Name (Legal Business Name): MILTON DOUGLAS MCLELLAND LPCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E 680 S
CEDAR CITY UT
84720-3593
US

IV. Provider business mailing address

245 E 680 S
CEDAR CITY UT
84720-3593
US

V. Phone/Fax

Practice location:
  • Phone: 435-867-7654
  • Fax: 435-867-7699
Mailing address:
  • Phone: 435-867-7654
  • Fax: 435-867-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8367569-6009
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: