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General NPI Number Information
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NPI Number | 1972910552
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Entity Type | Individual
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Provider Name | TRISTA MCCLELLAND MA LPC NCC
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Gender | Female
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 710 CHIPPEWA SQUARE SUITE 206
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City | MARQUETTE
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State | MI
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Zip | 49855
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Country | US
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Telephone | 906-225-3145
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 RUSSELL ST APT 1
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City | MARQUETTE
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State | MI
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Zip | 49855-2930
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Country | US
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Telephone | 906-869-1809
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401012673
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License Number State | MI
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