MEDICARE: SOYINI MCCLELLAN MS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1306611066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOYINI MCCLELLAN MS

Provider Business Mailing Address
First Line	:	4700 CITY AVE APT 6206
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-1587
Country	:	US
Telephone Number	:	215-888-2597
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 CITY AVE APT 6206
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-1587
Country	:	US
Telephone Number	:	215-888-2597
Fax Number	:

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

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/21/2023

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Directions to “ SOYINI MCCLELLAN MS” Practice Location

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