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NPI Code Detail

MEDICARE: CULLENA JILL MCCLANAHAN M.S.

MEDICARE: CULLENA JILL MCCLANAHAN M.S.
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
1103TS0200XSchool PsychologistWV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235619917
Entity Type Code : Individual
Provider Name (Legal Business Name) : CULLENA JILL MCCLANAHAN M.S.
Provider Business Mailing Address
First Line : 751 LEFT FORK ELK CRK
Second Line :
City : DELBARTON
State : WV
Zip : 25670-7340
Country : US
Telephone Number : 540-420-8881
Fax Number : 304-475-2011
Provider Business Practice Location Address
First Line : 41 W 5TH AVE
Second Line :
City : WILLIAMSON
State : WV
Zip : 25661-3201
Country : US
Telephone Number : 304-235-3390
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2018
Last Update Date : 08/21/2018

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