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General NPI Number Information
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NPI Number | 1124982822
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Entity Type | Individual
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Provider Name | TRENTON JAMES MCCLELLAN
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Gender | Male
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Dates
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Enumeration Date | 12/16/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 527 W 3RD ST
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City | KONAWA
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State | OK
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Zip | 74849-1415
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Country | US
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Telephone | 405-584-4078
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Fax |
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Provider Business Mailing Address
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Address Line | 527 W 3RD ST
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City | KONAWA
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State | OK
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Zip | 74849-1415
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Country | US
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Telephone | 405-584-4078
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | OK
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