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General NPI Number Information
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NPI Number | 1275283475
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Entity Type | Individual
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Provider Name | CASEY ALLEN MCCLELLAN LAMFT
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Gender | Male
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 1166 E WARNER RD 205
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City | GILBERT
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State | AZ
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Zip | 85296-3066
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Country | US
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Telephone | 480-702-1605
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Fax | 480-452-0435
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Provider Business Mailing Address
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Address Line | 1166 E WARNER RD STE 205
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City | GILBERT
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State | AZ
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Zip | 85296-3066
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Country | US
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Telephone | 480-702-1605
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Fax | 480-452-0435
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 10805
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License Number State | AZ
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