MEDICARE: TYANA SYMONE MCLEAN LCSWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P015407

General Provider Information

NPI Number	:	1174192322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYANA SYMONE MCLEAN LCSWA

Provider Business Mailing Address
First Line	:	319 S WESTGATE DR STE D
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1632
Country	:	US
Telephone Number	:	866-700-1606
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 S WESTGATE DR STE D
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1632
Country	:	US
Telephone Number	:	866-700-1606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	12/10/2025

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