Healthcare Provider Details

I. General information

NPI: 1235619917
Provider Name (Legal Business Name): CULLENA JILL MCCLANAHAN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 W 5TH AVE
WILLIAMSON WV
25661-3201
US

IV. Provider business mailing address

751 LEFT FORK ELK CRK
DELBARTON WV
25670-7340
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-3390
  • Fax:
Mailing address:
  • Phone: 540-420-8881
  • Fax: 304-475-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: