=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104347624
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSAY LEIGH MCCLANATHAN MS LPCMH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2017
-----------------------------------------------------
Last Update Date | 07/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 OLD LANDING RD
-----------------------------------------------------
City | MILLSBORO
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19966-1210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-947-1920
-----------------------------------------------------
Fax | 302-947-4645
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9064 N OLD STATE RD
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19960-3638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-228-3683
-----------------------------------------------------
Fax | 302-947-4645
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | AC-0000126
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------