MEDICARE: ANNIE MCLENNAN CSAC II

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	049	CA

General Provider Information

NPI Number	:	1710963541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE MCLENNAN CSAC II

Provider Business Mailing Address
First Line	:	2298 NORRIS AVE
Second Line	:
City	:	CRESCENT CITY
State	:	CA
Zip	:	95531-9344
Country	:	US
Telephone Number	:	707-464-2919
Fax Number	:	707-464-8218

Provider Business Practice Location Address
First Line	:	2298 NORRIS AVE
Second Line	:
City	:	CRESCENT CITY
State	:	CA
Zip	:	95531-9344
Country	:	US
Telephone Number	:	707-464-2919
Fax Number	:	707-464-8218

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	07/08/2007

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