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General NPI Number Information
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NPI Number | 1881704708
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Entity Type | Individual
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Provider Name | MICHELLE LYNNE MCCLELLAN PSY D
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 330 WEST TERRA COTTA AVE #9
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014
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Country | US
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Telephone | 847-254-0654
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Fax | 815-479-9146
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Provider Business Mailing Address
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Address Line | 330 WEST TERRA COTTA AVE #9
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014
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Country | US
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Telephone | 847-254-0654
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Fax | 815-479-9146
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2778-57
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-006469
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0.71006469
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4245
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License Number State | AZ
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